Provider Demographics
NPI:1255860458
Name:MITCHELL, ANGELA N (LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:N
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4620 BUCK RUN DR APT D
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-9042
Mailing Address - Country:US
Mailing Address - Phone:540-293-9788
Mailing Address - Fax:
Practice Address - Street 1:5215 STARKEY RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-9359
Practice Address - Country:US
Practice Address - Phone:540-293-9788
Practice Address - Fax:540-904-7731
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-09
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040099101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical