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General NPI Number Information
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NPI Number | 1184381683
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Entity Type | Individual
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Provider Name | CHARLOTTE MITCHELL BCBA
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Gender | Female
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Dates
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Enumeration Date | 11/19/2021
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 412 RIVER STA
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City | CIBOLO
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State | TX
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Zip | 78108-0120
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Country | US
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Telephone | 912-856-2430
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Fax |
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Provider Business Mailing Address
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Address Line | 6003 VETERANS PKWY STE 206
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City | COLUMBUS
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State | GA
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Zip | 31909-6200
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Country | US
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Telephone | 912-856-2430
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 7501
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License Number State | TX
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