Provider Demographics
NPI:1114407905
Name:MITCHELL, LORRIE MAE (LMSW-CC)
Entity Type:Individual
Prefix:
First Name:LORRIE
Middle Name:MAE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 LILY RD
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04429-4825
Mailing Address - Country:US
Mailing Address - Phone:207-356-4036
Mailing Address - Fax:
Practice Address - Street 1:315 LILY RD
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:ME
Practice Address - Zip Code:04429-4825
Practice Address - Country:US
Practice Address - Phone:207-356-4036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC16869101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health