Provider Demographics
NPI:1891097440
Name:MITCHELL, VANESSA LYNNE (LMSW, ACSW, MAC)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:LYNNE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LMSW, ACSW, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 450
Mailing Address - Street 2:BOX 402
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96206-0001
Mailing Address - Country:US
Mailing Address - Phone:011822-706-6726
Mailing Address - Fax:
Practice Address - Street 1:PSC 450
Practice Address - Street 2:BOX 402
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96206-0001
Practice Address - Country:US
Practice Address - Phone:011822-706-6726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV24620101YA0400X
MI68010874851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV24620OtherNATIONAL ASSOCIATION OF FORENIC COUNSELORS
MI6801087485OtherSTATE OF MICHIGAN DEPT OF COMMUNITY HEALTH