Provider Demographics
NPI:1629405733
Name:MITCHELL, SHERETTA SHREE (MS,LCAS-A)
Entity Type:Individual
Prefix:
First Name:SHERETTA
Middle Name:SHREE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MS,LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2216 W MEADOWVIEW RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-3406
Mailing Address - Country:US
Mailing Address - Phone:336-854-2655
Mailing Address - Fax:336-791-2188
Practice Address - Street 1:2216 W MEADOWVIEW RD
Practice Address - Street 2:SUITE 204
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-3406
Practice Address - Country:US
Practice Address - Phone:336-854-2655
Practice Address - Fax:336-791-2188
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3409-A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)