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General NPI Number Information
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NPI Number | 1003164245
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Entity Type | Individual
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Provider Name | NICHOLAS JAMES MITCHELL LMSW
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Gender | Male
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Dates
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Enumeration Date | 08/20/2012
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Last Update Date | 10/16/2019
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Provider Practice Location Address
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Address Line | 10299 GRAND RIVER RD STE P
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City | BRIGHTON
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State | MI
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Zip | 48116-9558
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Country | US
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Telephone | 810-225-9550
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Fax |
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Provider Business Mailing Address
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Address Line | 622 E GRAND RIVER AVE
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City | HOWELL
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State | MI
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Zip | 48843-2329
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Country | US
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Telephone | 517-548-0081
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 2-01173
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801093133
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801093133
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License Number State | MI
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