Provider Demographics
NPI:1083016315
Name:MITCHELL, CHRISTY (MED)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MED
Other - Prefix:MRS
Other - First Name:CHRISTY
Other - Middle Name:RUSVEETA
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED
Mailing Address - Street 1:PO BOX 667
Mailing Address - Street 2:
Mailing Address - City:DENMARK
Mailing Address - State:SC
Mailing Address - Zip Code:29042-0667
Mailing Address - Country:US
Mailing Address - Phone:803-464-7052
Mailing Address - Fax:
Practice Address - Street 1:1000 BROOKHAVEN DR
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-2109
Practice Address - Country:US
Practice Address - Phone:803-641-2624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist