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General NPI Number Information
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NPI Number | 1932444106
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Entity Type | Individual
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Provider Name | LADORTHA J MITCHELL-YOUNG MSW. LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/29/2012
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Last Update Date | 04/29/2022
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Provider Practice Location Address
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Address Line | 3921 N MERIDIAN ST STE 102
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City | INDIANAPOLIS
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State | IN
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Zip | 46208-4061
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Country | US
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Telephone | 317-252-5258
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Fax |
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Provider Business Mailing Address
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Address Line | 4942 ALLISONVILLE RD UNIT B
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City | INDIANAPOLIS
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State | IN
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Zip | 46205-1538
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Country | US
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Telephone | 317-550-6229
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 99072042A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34009677A
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License Number State | IN
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