Provider Demographics
NPI:1073604922
Name:MITCHELL, ROBERT ALLAN (LISW LICDC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALLAN
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:LISW LICDC
Other - Prefix:MR
Other - First Name:ROBERT
Other - Middle Name:ALLAN
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LISW LICDC
Mailing Address - Street 1:2995 E OVERLOOK RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-2435
Mailing Address - Country:US
Mailing Address - Phone:216-570-8108
Mailing Address - Fax:216-397-1107
Practice Address - Street 1:2995 E OVERLOOK RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-2435
Practice Address - Country:US
Practice Address - Phone:216-570-8108
Practice Address - Fax:216-397-1107
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH01137101YA0400X
OHOHIO00073331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical