Provider Demographics
NPI:1447617097
Name:MITCH PC
Entity Type:Organization
Organization Name:MITCH PC
Other - Org Name:CENTER OF HOPE COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:989-954-4673
Mailing Address - Street 1:1001 FAIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-4317
Mailing Address - Country:US
Mailing Address - Phone:989-954-4673
Mailing Address - Fax:
Practice Address - Street 1:1001 FAIRFIELD DR
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-4317
Practice Address - Country:US
Practice Address - Phone:989-954-4673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401005318101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6401005318OtherSTATE LICENSE NUMBER