Provider Demographics
NPI:1922754761
Name:VACANTI-MITCHELL, KATLYN JO (LMSW)
Entity Type:Individual
Prefix:
First Name:KATLYN
Middle Name:JO
Last Name:VACANTI-MITCHELL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:2953 KINWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-1339
Mailing Address - Country:US
Mailing Address - Phone:615-988-4763
Mailing Address - Fax:
Practice Address - Street 1:1 VANTAGE WAY STE E130
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37228-1591
Practice Address - Country:US
Practice Address - Phone:615-988-4763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13647101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health