Provider Demographics
NPI:1851002158
Name:MITCHELL, IVEY ANNETTE
Entity Type:Individual
Prefix:DR
First Name:IVEY
Middle Name:ANNETTE
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 1:96679 COMMODORE POINT DR
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-6567
Mailing Address - Country:US
Mailing Address - Phone:239-634-0743
Mailing Address - Fax:
Practice Address - Street 1:96679 COMMODORE POINT DR
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-6567
Practice Address - Country:US
Practice Address - Phone:239-634-0743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1685103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool