Provider Demographics
NPI:1902013220
Name:MITCHELL, ALBERTINA ROLLINS (MSW LICSW)
Entity Type:Individual
Prefix:MRS
First Name:ALBERTINA
Middle Name:ROLLINS
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4745 MILLRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HUBER HGTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424
Mailing Address - Country:US
Mailing Address - Phone:937-901-4139
Mailing Address - Fax:937-233-1634
Practice Address - Street 1:135 W DOROTHY LN
Practice Address - Street 2:SUITE #205
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-1489
Practice Address - Country:US
Practice Address - Phone:937-901-4139
Practice Address - Fax:937-233-1634
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00096251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical