MEDICARE: VALERIE L 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	172V00000X	Community Health Worker	166753044	MI
2	253Z00000X	In Home Supportive Care Agency
3	101Y00000X	Counselor
4	101YM0800X	Mental Health Counselor
5	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1942161419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE L MITCHELL

Provider Business Mailing Address
First Line	:	15330 LAHSER RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48223-1527
Country	:	US
Telephone Number	:	313-974-1505
Fax Number	:

Provider Business Practice Location Address
First Line	:	15330 LAHSER RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48223-1527
Country	:	US
Telephone Number	:	313-974-1505
Fax Number	:

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

Provider Enumeration Date	:	11/22/2025
Last Update Date	:	03/18/2026

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Directions to “ VALERIE L MITCHELL ” Practice Location

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