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General NPI Number Information
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NPI Number | 1730547266
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Entity Type | Organization
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Legal Business Name | COLLEEN D MITCHELL, PHD, LLC
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Dates
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Enumeration Date | 01/28/2016
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Last Update Date | 03/21/2016
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Provider Practice Location Address
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Address Line | 8101 SANDY SPRING RD SUITE 100F
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City | LAUREL
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State | MD
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Zip | 20707-3596
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Country | US
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Telephone | 951-536-3682
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Fax |
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Provider Business Mailing Address
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Address Line | 3505 TURBRIDGE DR
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City | BURTONSVILLE
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State | MD
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Zip | 20866-2009
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Country | US
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Telephone | 951-536-3682
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Fax | 301-890-0214
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. COLLEEN DENISE MITCHELL
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Credential | PHD
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Telephone | 951-536-3682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 05644
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License Number State | MD
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