MEDICARE: MRS. CIERRA MITCHELL

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
1	103TC1900X	Counseling Psychologist

General Provider Information

NPI Number	:	1346567906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CIERRA MITCHELL

Provider Business Mailing Address
First Line	:	403 WESTVIEW DR
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-5582
Country	:	US
Telephone Number	:	757-358-7654
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 DIAGONAL RD STE 600
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-2840
Country	:	US
Telephone Number	:	703-647-6034
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2010
Last Update Date	:	04/22/2010

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Directions to “ MRS. CIERRA MITCHELL ” Practice Location

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