Provider Demographics
NPI:1326600784
Name:MITCHELL, KYLE (LCADC, CSW)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LCADC, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 LEVI JACKSON MILL RD STE A
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40744-8325
Mailing Address - Country:US
Mailing Address - Phone:606-682-5502
Mailing Address - Fax:
Practice Address - Street 1:280 LEVI JACKSON MILL RD STE A
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40744-8325
Practice Address - Country:US
Practice Address - Phone:606-682-5502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)