MEDICARE: MS. LISA FAWN MITCHELL LCPC

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	101YM0800X	Mental Health Counselor	LC1005	MD

General Provider Information

NPI Number	:	1932361581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA FAWN MITCHELL LCPC

Provider Business Mailing Address
First Line	:	2545 LITTLE VISTA TER
Second Line	:
City	:	OLNEY
State	:	MD
Zip	:	20832-1568
Country	:	US
Telephone Number	:	240-498-9089
Fax Number	:	301-738-9901

Provider Business Practice Location Address
First Line	:	2545 LITTLE VISTA TER
Second Line	:
City	:	OLNEY
State	:	MD
Zip	:	20832-1568
Country	:	US
Telephone Number	:	240-498-9089
Fax Number	:	301-738-9901

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

Provider Enumeration Date	:	06/25/2008
Last Update Date	:	10/15/2024

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