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NPI Code Detail

MEDICARE: MRS. ANGELA LYNN MITCHELL LSWAIC, SUDP

MEDICARE: MRS. ANGELA LYNN MITCHELL LSWAIC, SUDP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselorSWIA.SC.70117779WA
2101YA0400XAddiction (Substance Use Disorder) CounselorCP60983348WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1285133876
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ANGELA LYNN MITCHELL LSWAIC, SUDP
Provider Business Mailing Address
First Line : PO BOX 2429
Second Line :
City : LONGVIEW
State : WA
Zip : 98632-8486
Country : US
Telephone Number : 360-353-9494
Fax Number : 360-355-9440
Provider Business Practice Location Address
First Line : 900 FIR ST
Second Line :
City : LONGVIEW
State : WA
Zip : 98632-2544
Country : US
Telephone Number : 360-575-3316
Fax Number : 360-353-9440
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2018
Last Update Date : 06/16/2026

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