Provider Demographics
NPI:1598922445
Name:MITCHELL, FAITH ANNE (MFT)
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:ANNE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 THE VLG
Mailing Address - Street 2:STE 305
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-2518
Mailing Address - Country:US
Mailing Address - Phone:310-909-9951
Mailing Address - Fax:310-372-2429
Practice Address - Street 1:120 THE VLG
Practice Address - Street 2:STE 305
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-2518
Practice Address - Country:US
Practice Address - Phone:310-909-9951
Practice Address - Fax:310-372-2429
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC30529106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist