Provider Demographics
NPI:1922130780
Name:MITCHELL, REBECCA SHEILA
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:SHEILA
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1235 MCHENRY AVE
Mailing Address - Street 2:SUITES A AND B
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-5370
Mailing Address - Country:US
Mailing Address - Phone:209-527-4597
Mailing Address - Fax:209-527-4599
Practice Address - Street 1:1235 MCHENRY AVE
Practice Address - Street 2:SUITES A AND B
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-5370
Practice Address - Country:US
Practice Address - Phone:209-527-4597
Practice Address - Fax:209-527-4599
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program