Provider Demographics
NPI:1003541517
Name:MITCHELL, TRAVIA L
Entity Type:Individual
Prefix:
First Name:TRAVIA
Middle Name:L
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TRAVIA
Other - Middle Name:L
Other - Last Name:PICKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3339 DUKE ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-5219
Mailing Address - Country:US
Mailing Address - Phone:038-703-8807
Mailing Address - Fax:
Practice Address - Street 1:3339 DUKE ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-5219
Practice Address - Country:US
Practice Address - Phone:703-870-3880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician