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General NPI Number Information
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NPI Number | 1821684093
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Entity Type | Individual
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Provider Name | LATESHA SHADAWN MITCHELL LMFT
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Gender | Female
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Dates
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Enumeration Date | 12/11/2020
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Last Update Date | 12/14/2020
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Provider Practice Location Address
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Address Line | 2310 PARKLAKE DR NE STE 171
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City | ATLANTA
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State | GA
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Zip | 30345-2933
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Country | US
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Telephone | 770-569-3640
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Fax | 678-526-5188
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Provider Business Mailing Address
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Address Line | 1313 E WALDBURG ST
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City | SAVANNAH
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State | GA
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Zip | 31404-2035
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Country | US
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Telephone | 912-247-1178
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT001802
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License Number State | GA
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