Provider Demographics
NPI:1578010401
Name:MITCHELL-ROGERS, PAMELA MARIE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:MARIE
Last Name:MITCHELL-ROGERS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:MARIE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:SAN DIEGO COUNTY SHERIFF HEADQUARTERS
Mailing Address - Street 2:9621 RIDGEHAVEN COURT
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126
Mailing Address - Country:US
Mailing Address - Phone:858-974-2222
Mailing Address - Fax:
Practice Address - Street 1:VISTA DETENTION FACILITY
Practice Address - Street 2:325 SOUTH MELROSE DRIVE #200
Practice Address - City:VISTAA
Practice Address - State:CA
Practice Address - Zip Code:92081
Practice Address - Country:US
Practice Address - Phone:670-940-4803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61138561101YM0800X
CA127997106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health