Provider Demographics
NPI:1316207558
Name:MITCHELL, PENNY MARIE (ALC)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:MARIE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 GOLDENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:AL
Mailing Address - Zip Code:35570-3571
Mailing Address - Country:US
Mailing Address - Phone:205-570-8233
Mailing Address - Fax:205-449-0049
Practice Address - Street 1:1817 WOODSPRINGS RD STE G
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6093
Practice Address - Country:US
Practice Address - Phone:870-934-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor