Provider Demographics
NPI:1003257841
Name:MITCHELL, LATOYA MARIE
Entity Type:Individual
Prefix:MRS
First Name:LATOYA
Middle Name:MARIE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:CA
Mailing Address - Zip Code:93215-2238
Mailing Address - Country:US
Mailing Address - Phone:661-721-0463
Mailing Address - Fax:661-721-0482
Practice Address - Street 1:1019 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-2238
Practice Address - Country:US
Practice Address - Phone:661-721-0463
Practice Address - Fax:661-721-0482
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARI-M1308062007101YA0400X
CAR1290740218101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)