Provider Demographics
NPI:1437488368
Name:MITCHELL, MONICA (MONICA MITCHELL)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MONICA MITCHELL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PETTINARO DR
Mailing Address - Street 2:APT.G6
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-1559
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 PETTINARO DR
Practice Address - Street 2:APT G6
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921
Practice Address - Country:US
Practice Address - Phone:215-520-6910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-24
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor