Provider Demographics
NPI:1659886877
Name:MITCHELL, ABBY LYNNE (LCSW)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:LYNNE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RODMAN AVE WOODSON HEALTH CLINIC
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61299-0001
Mailing Address - Country:US
Mailing Address - Phone:309-782-4818
Mailing Address - Fax:
Practice Address - Street 1:1 RODMAN AVE WOODSON HEALTH CLINIC
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61299-0001
Practice Address - Country:US
Practice Address - Phone:309-782-4818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-11
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.016560104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker