MEDICARE: MRS. VANESSA LYNNE MITCHELL LMSW, ACSW, MAC

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	24620	NV
2	1041C0700X	Clinical Social Worker	6801087485	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	24620	OTHER	NV	NATIONAL ASSOCIATION OF FORENIC COUNSELORS
2	6801087485	OTHER	MI	STATE OF MICHIGAN DEPT OF COMMUNITY HEALTH

General Provider Information

NPI Number	:	1891097440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VANESSA LYNNE MITCHELL LMSW, ACSW, MAC

Provider Business Mailing Address
First Line	:	PSC 450
Second Line	:	BOX 402
City	:	APO
State	:	AP
Zip	:	96206-0001
Country	:	US
Telephone Number	:	0118227066726
Fax Number	:

Provider Business Practice Location Address
First Line	:	PSC 450
Second Line	:	BOX 402
City	:	APO
State	:	AP
Zip	:	96206-0001
Country	:	US
Telephone Number	:	0118227066726
Fax Number	:

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

Provider Enumeration Date	:	12/01/2010
Last Update Date	:	12/02/2010

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