Provider Demographics
NPI:1508111014
Name:MITCHELL, ROY (BS, CAC)
Entity Type:Individual
Prefix:MR
First Name:ROY
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:BS, CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 N LOBDELL BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-8811
Mailing Address - Country:US
Mailing Address - Phone:225-248-6943
Mailing Address - Fax:225-248-6943
Practice Address - Street 1:921 N LOBDELL BLVD STE G
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-8811
Practice Address - Country:US
Practice Address - Phone:225-248-6943
Practice Address - Fax:225-248-6943
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACAC 1083101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)