Provider Demographics
NPI:1558476341
Name:MITCHELL, AGNETA (PHD)
Entity Type:Individual
Prefix:
First Name:AGNETA
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4010
Mailing Address - Country:US
Mailing Address - Phone:410-522-1181
Mailing Address - Fax:410-522-1182
Practice Address - Street 1:3200 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-4010
Practice Address - Country:US
Practice Address - Phone:410-522-1181
Practice Address - Fax:410-522-1182
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03553103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical