Provider Demographics
NPI:1629208517
Name:MITCHELL-BLITCH, MELISSA (LPC, CACII)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MITCHELL-BLITCH
Suffix:
Gender:F
Credentials:LPC, CACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 FOLLY RD
Mailing Address - Street 2:SUITE P222
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-3019
Mailing Address - Country:US
Mailing Address - Phone:843-371-6067
Mailing Address - Fax:
Practice Address - Street 1:886 JOHNNIE DODDS BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3190
Practice Address - Country:US
Practice Address - Phone:843-371-6067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-26
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4916101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional