Provider Demographics
NPI:1578768198
Name:BOSTON-MITCHELL, RENEE CHICAWN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:CHICAWN
Last Name:BOSTON-MITCHELL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43067 HIDDENCOVE CT
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-3285
Mailing Address - Country:US
Mailing Address - Phone:734-772-2500
Mailing Address - Fax:
Practice Address - Street 1:10900 HARPER AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-3364
Practice Address - Country:US
Practice Address - Phone:313-579-5989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801081042104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker