Provider Demographics
NPI:1376908228
Name:MITCHELL, CARRIE ADELINE (MSW, LCSW, LCASA)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:ADELINE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MSW, LCSW, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 LEYLAND CYPRESS LN
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-2501
Mailing Address - Country:US
Mailing Address - Phone:919-389-5484
Mailing Address - Fax:919-552-9544
Practice Address - Street 1:441 LEYLAND CYPRESS LN
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526
Practice Address - Country:US
Practice Address - Phone:919-389-5484
Practice Address - Fax:919-552-9544
Is Sole Proprietor?:No
Enumeration Date:2015-12-19
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0097891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical