MEDICARE: NICOLE LYN MITCHELL LADC

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	151.0127661	VT
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	0899	NH

General Provider Information

NPI Number	:	1538401401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE LYN MITCHELL LADC

Provider Business Mailing Address
First Line	:	3801 DARTMOUTH COLLEGE HWY
Second Line	:
City	:	NORTH HAVERHILL
State	:	NH
Zip	:	03774-4909
Country	:	US
Telephone Number	:	603-787-2042
Fax Number	:	603-787-2044

Provider Business Practice Location Address
First Line	:	3801 DARTMOUTH COLLEGE HWY
Second Line	:
City	:	NORTH HAVERHILL
State	:	NH
Zip	:	03774-4909
Country	:	US
Telephone Number	:	603-787-2042
Fax Number	:	603-787-2044

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

Provider Enumeration Date	:	03/19/2013
Last Update Date	:	03/28/2023

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