Provider Demographics
NPI:1275767642
Name:MITCHELL, ANGIE CHRISTINA (LPC - MHSP)
Entity Type:Individual
Prefix:MRS
First Name:ANGIE
Middle Name:CHRISTINA
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LPC - MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7209 HAMILTON ACRES CIR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-8623
Mailing Address - Country:US
Mailing Address - Phone:423-499-9335
Mailing Address - Fax:423-499-9334
Practice Address - Street 1:7209 HAMILTON ACRES CIR
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-8623
Practice Address - Country:US
Practice Address - Phone:423-499-9335
Practice Address - Fax:423-499-9334
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2011-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2624101YP2500X
GALPC006282101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional