MEDICARE: SARA AMBERLY MITCHELL LICDC, LPC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	LICDC.162880	OH
2	101YP2500X	Professional Counselor	C.2507348	OH

General Provider Information

NPI Number	:	1457829871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA AMBERLY MITCHELL LICDC, LPC

Provider Business Mailing Address
First Line	:	4600 MONTGOMERY RD STE 400
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-2600
Country	:	US
Telephone Number	:	833-510-4357
Fax Number	:	866-460-2997

Provider Business Practice Location Address
First Line	:	974 N 21ST ST
Second Line	:
City	:	NEWARK
State	:	OH
Zip	:	43055-2990
Country	:	US
Telephone Number	:	833-510-4357
Fax Number	:

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

Provider Enumeration Date	:	11/03/2018
Last Update Date	:	05/28/2026

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