Provider Demographics
NPI:1861629487
Name:MITCHELL4D, LLC
Entity Type:Organization
Organization Name:MITCHELL4D, LLC
Other - Org Name:SIEBEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:YOLONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-453-1993
Mailing Address - Street 1:8105 OLD CONCORD RD
Mailing Address - Street 2:502
Mailing Address - City:NEWELL
Mailing Address - State:NC
Mailing Address - Zip Code:28126-9999
Mailing Address - Country:US
Mailing Address - Phone:704-453-1993
Mailing Address - Fax:704-248-8392
Practice Address - Street 1:7736 WATERFORD LAKES DR
Practice Address - Street 2:SUITE 1423
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-7485
Practice Address - Country:US
Practice Address - Phone:704-453-1993
Practice Address - Fax:704-248-8392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health