Provider Demographics
NPI:1790976678
Name:MITCHELL, JUANITA L (LMHC CPT CAS MS)
Entity Type:Individual
Prefix:MRS
First Name:JUANITA
Middle Name:L
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LMHC CPT CAS MS
Other - Prefix:
Other - First Name:JUANITA
Other - Middle Name:L
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4317 E GENESEE ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13214-2114
Mailing Address - Country:US
Mailing Address - Phone:315-569-1968
Mailing Address - Fax:
Practice Address - Street 1:4317 E GENESEE ST
Practice Address - Street 2:SUITE 105
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13214-2114
Practice Address - Country:US
Practice Address - Phone:315-569-1968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000824 1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health