Provider Demographics
NPI:1588008072
Name:MITCHELL, MARLA (LLMSW)
Entity type:Individual
Prefix:
First Name:MARLA
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2651 APACHE TRL
Mailing Address - Street 2:
Mailing Address - City:WIXOM
Mailing Address - State:MI
Mailing Address - Zip Code:48393-2119
Mailing Address - Country:US
Mailing Address - Phone:248-668-0933
Mailing Address - Fax:
Practice Address - Street 1:5745 W. MAPLE ROAD
Practice Address - Street 2:SUITE 205
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322
Practice Address - Country:US
Practice Address - Phone:248-413-5817
Practice Address - Fax:248-429-2132
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801108571104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker