Provider Demographics
NPI:1437503331
Name:CARRIE MITCHELL COUNSELING, PLLC
Entity Type:Organization
Organization Name:CARRIE MITCHELL COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:ADELINE
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, LCASA
Authorized Official - Phone:919-389-5484
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 1:602 E ACADEMY ST
Practice Address - Street 2:SUITE 201
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-2382
Practice Address - Country:US
Practice Address - Phone:919-389-5484
Practice Address - Fax:919-552-9544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-17
Last Update Date:2016-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0097891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty