Provider Demographics
NPI:1700203536
Name:MITCHELL, PHILIP (LPC)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S 11TH ST
Mailing Address - Street 2:APT 3121
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-1942
Mailing Address - Country:US
Mailing Address - Phone:757-775-5814
Mailing Address - Fax:804-695-8122
Practice Address - Street 1:1041 SHARON RD
Practice Address - Street 2:STE 201
Practice Address - City:KING WILLIAM
Practice Address - State:VA
Practice Address - Zip Code:23086-3347
Practice Address - Country:US
Practice Address - Phone:804-769-2751
Practice Address - Fax:804-769-3125
Is Sole Proprietor?:No
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005707101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1497717615Medicaid