Provider Demographics
NPI:1407164726
Name:MITCHELL, DORA DENISE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:DORA
Middle Name:DENISE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:DORA
Other - Middle Name:DENISE
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PLPC
Mailing Address - Street 1:P.O. BOX 1091
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-2200
Mailing Address - Country:US
Mailing Address - Phone:573-221-2273
Mailing Address - Fax:573-221-1720
Practice Address - Street 1:#2 MELGROVE LANE
Practice Address - Street 2:SUITE 100
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-2200
Practice Address - Country:US
Practice Address - Phone:573-221-2273
Practice Address - Fax:573-221-1720
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010032746101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor