Provider Demographics
NPI:1891852059
Name:MITCHELL, MICHAEL RICKEY (LMFT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:RICKEY
Last Name:MITCHELL
Suffix:
Gender:M
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:PO BOX 487
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30031-0487
Mailing Address - Country:US
Mailing Address - Phone:404-743-1094
Mailing Address - Fax:
Practice Address - Street 1:699 PIEDMONT AVE NE STE B2
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-1400
Practice Address - Country:US
Practice Address - Phone:404-743-1094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA10073101YA0400X
GA000712106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist