Healthcare Provider Details

I. General information

NPI: 1134438385
Provider Name (Legal Business Name): MELISSA EILEEN MITCHELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 10/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8140 ASHTON AVE SUITE 200
MANASSAS VA
20109-5698
US

IV. Provider business mailing address

260 S REYNOLDS ST APT 811
ALEXANDRIA VA
22304-4400
US

V. Phone/Fax

Practice location:
  • Phone: 703-330-9933
  • Fax: 703-368-8454
Mailing address:
  • Phone: 410-707-6794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904007456
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: