Provider Demographics
NPI:1013403617
Name:MITCHELL, ALICIA L
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:L
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 1:2414 FERRAND ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3249
Mailing Address - Country:US
Mailing Address - Phone:318-325-0072
Mailing Address - Fax:318-325-0070
Practice Address - Street 1:2414 FERRAND ST STE 1
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3249
Practice Address - Country:US
Practice Address - Phone:318-325-0072
Practice Address - Fax:318-325-0070
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator