Provider Demographics
NPI:1639758477
Name:MITCHELL, CARRIE LOEL (HEALTH COACH)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:LOEL
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:HEALTH COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 THE CITY DR S BLDG 53
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3298
Mailing Address - Country:US
Mailing Address - Phone:714-456-7514
Mailing Address - Fax:714-456-2842
Practice Address - Street 1:101 THE CITY DR S BLDG 53
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3298
Practice Address - Country:US
Practice Address - Phone:714-456-7514
Practice Address - Fax:714-456-2842
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1689608150Medicaid