Provider Demographics
NPI:1508639196
Name:MITCHEM, ARIANA NICOLE
Entity Type:Individual
Prefix:
First Name:ARIANA
Middle Name:NICOLE
Last Name:MITCHEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 OLD STEINE RD APT 1413
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-6725
Mailing Address - Country:US
Mailing Address - Phone:704-230-7486
Mailing Address - Fax:
Practice Address - Street 1:1945 J N PEASE PL STE 102
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4555
Practice Address - Country:US
Practice Address - Phone:704-405-8890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0198991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical