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General NPI Number Information
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NPI Number | 1609882646
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Entity Type | Individual
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Provider Name | DAVID RICHARD MITCHELL MSW, LCSW
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Gender | Male
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 04/09/2019
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Provider Practice Location Address
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Address Line | 6098 DEBRA RD STE 5200
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City | CHATTANOOGA
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State | TN
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Zip | 37411-5702
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Country | US
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Telephone | 423-893-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 2307 MAG WILLIAMS RD
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City | CHICKAMAUGA
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State | GA
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Zip | 30707-6039
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Country | US
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Telephone | 708-476-9192
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149-001264
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License Number State | IL
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