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General NPI Number Information
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NPI Number | 1780129833
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Entity Type | Organization
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Legal Business Name | CHRISTINA M MITCHAM PLLC
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Dates
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Enumeration Date | 12/28/2016
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Last Update Date | 08/13/2021
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Provider Practice Location Address
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Address Line | 1749 HAMILTON RD SUITE 203
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City | OKEMOS
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State | MI
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Zip | 48864
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Country | US
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Telephone | 517-331-9099
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Fax | 517-993-5713
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Provider Business Mailing Address
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Address Line | 1749 HAMILTON RD SUITE 203
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City | OKEMOS
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State | MI
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Zip | 48864
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Country | US
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Telephone | 517-331-9099
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Fax | 517-993-5713
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Authorized Official
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Title or Position | PSYCHOTHERAPIST / OWNER
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Name | MRS. CHRISTINA M MITCHAM
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Credential | LCSW
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Telephone | 616-706-2725
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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 | 6801088032
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License Number State | MI
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