Provider Demographics
NPI:1497939250
Name:MITCHELL, ELLEN P (LISW)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:P
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 OAK COVE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7501
Mailing Address - Country:US
Mailing Address - Phone:803-419-5238
Mailing Address - Fax:
Practice Address - Street 1:112 OAK COVE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7501
Practice Address - Country:US
Practice Address - Phone:803-419-5238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC84471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical