Provider Demographics
NPI:1073851036
Name:MITCHELL, SKIY (LAPC, CACI, NBCC)
Entity Type:Individual
Prefix:
First Name:SKIY
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LAPC, CACI, NBCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 BLACK OAK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-5353
Mailing Address - Country:US
Mailing Address - Phone:912-373-5321
Mailing Address - Fax:
Practice Address - Street 1:723 BLACK OAK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-5353
Practice Address - Country:US
Practice Address - Phone:912-373-5321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-26
Last Update Date:2013-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No385H00000XRespite Care FacilityRespite Care