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General NPI Number Information
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NPI Number | 1659046720
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Entity Type | Individual
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Provider Name | WISTER MITCHELSON
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Gender | Male
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Dates
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Enumeration Date | 08/11/2021
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 78 MAIN ST
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City | STANARDSVILLE
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State | VA
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Zip | 22973-2297
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Country | US
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Telephone | 434-260-4869
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Fax |
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Provider Business Mailing Address
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Address Line | 78 MAIN ST
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City | STANARDSVILLE
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State | VA
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Zip | 22973
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Country | US
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Telephone | 434-260-4869
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701010642
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License Number State | VA
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