Provider Demographics
NPI:1881864221
Name:MITCHELL, TEDDI ANN (MA, LPC)
Entity Type:Individual
Prefix:
First Name:TEDDI
Middle Name:ANN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 E 5TH AVE STE B
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-3128
Mailing Address - Country:US
Mailing Address - Phone:706-509-0130
Mailing Address - Fax:706-237-6503
Practice Address - Street 1:106 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-3128
Practice Address - Country:US
Practice Address - Phone:706-509-0130
Practice Address - Fax:706-237-6503
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490032907Medicaid