Provider Demographics
NPI:1558594101
Name:MITCHELL, JEAN THERESE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:THERESE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:THERESE
Other - Last Name:SUTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1611 EASTCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-2354
Mailing Address - Country:US
Mailing Address - Phone:919-316-8375
Mailing Address - Fax:
Practice Address - Street 1:1611 EASTCHESTER DR
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-2354
Practice Address - Country:US
Practice Address - Phone:919-316-8375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP005292104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC012988OtherNORTH CAROLINA SOCIAL WORK CERTIFICATION AND LICENSURE BOARD