Provider Demographics
NPI:1477936474
Name:MITCHELL, GEORGE DOUGLAS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:DOUGLAS
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:110 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-3362
Mailing Address - Country:US
Mailing Address - Phone:479-968-1298
Mailing Address - Fax:870-933-9395
Practice Address - Street 1:106 MOUNTAIN PLACE DRIVE
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:AR
Practice Address - Zip Code:72560-6800
Practice Address - Country:US
Practice Address - Phone:870-269-4193
Practice Address - Fax:870-269-4199
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7963-M1041C0700X
171M00000X
AR7963-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator