Provider Demographics
NPI:1760640254
Name:MITCHELL, DEBORAH
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19345 PATTON ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-2530
Mailing Address - Country:US
Mailing Address - Phone:313-742-6016
Mailing Address - Fax:
Practice Address - Street 1:19940 CONANT ST STE ABC
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-1494
Practice Address - Country:US
Practice Address - Phone:313-733-4528
Practice Address - Fax:313-733-4532
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 101YA0400X
MI6803086683104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)