Provider Demographics
NPI:1003206947
Name:MITCHELL, KOLLEEN (LAC, FABORM)
Entity Type:Individual
Prefix:
First Name:KOLLEEN
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LAC, FABORM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 S ESTES DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2866
Mailing Address - Country:US
Mailing Address - Phone:919-933-4480
Mailing Address - Fax:
Practice Address - Street 1:104 S ESTES DR
Practice Address - Street 2:SUITE 104
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2866
Practice Address - Country:US
Practice Address - Phone:919-933-4480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC370171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist