Provider Demographics
NPI:1346375805
Name:MITCHELL, VIRGINIA D (LAC)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:D
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1058 TREVINO LN
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-3451
Mailing Address - Country:US
Mailing Address - Phone:703-326-1255
Mailing Address - Fax:
Practice Address - Street 1:1058 TREVINO LN
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-3451
Practice Address - Country:US
Practice Address - Phone:703-326-1255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist