Provider Demographics
NPI:1720544406
Name:MITCHELL, JANNIA MARIE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:JANNIA
Middle Name:MARIE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:JANNIA
Other - Middle Name:MARIE
Other - Last Name:FARMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1978
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21802-1978
Mailing Address - Country:US
Mailing Address - Phone:410-749-1015
Mailing Address - Fax:410-749-0654
Practice Address - Street 1:222 MILDALE DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-7302
Practice Address - Country:US
Practice Address - Phone:443-754-0436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-18
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19746104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid