Provider Demographics
NPI:1821684093
Name:MITCHELL, LATESHA SHADAWN (LMFT)
Entity Type:Individual
Prefix:
First Name:LATESHA
Middle Name:SHADAWN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 E WALDBURG ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-2035
Mailing Address - Country:US
Mailing Address - Phone:912-247-1178
Mailing Address - Fax:
Practice Address - Street 1:2310 PARKLAKE DR NE STE 171
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-2933
Practice Address - Country:US
Practice Address - Phone:770-569-3640
Practice Address - Fax:678-526-5188
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001802106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist