Provider Demographics
NPI:1083051767
Name:MITCHELL, LEANNE FRANCES (BA, SST)
Entity Type:Individual
Prefix:MRS
First Name:LEANNE
Middle Name:FRANCES
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:BA, SST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 EMMONS BLVD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-3146
Mailing Address - Country:US
Mailing Address - Phone:313-333-2559
Mailing Address - Fax:
Practice Address - Street 1:921 HOWARD ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2210
Practice Address - Country:US
Practice Address - Phone:313-274-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6803085253104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker