Provider Demographics
NPI:1699376194
Name:MITCHELL, CAITLYN MACKENZIE (MA, LGPC)
Entity Type:Individual
Prefix:
First Name:CAITLYN
Middle Name:MACKENZIE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MA, LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 AIKENS CTR STE 304
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-6201
Mailing Address - Country:US
Mailing Address - Phone:304-440-9955
Mailing Address - Fax:
Practice Address - Street 1:3094 CHARLES TOWN RD
Practice Address - Street 2:
Practice Address - City:KEARNEYSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25430-2669
Practice Address - Country:US
Practice Address - Phone:703-049-0120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MDLGP11756101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)