Provider Demographics
NPI:1932460912
Name:MITCHELL, MARY LINNEA (MSW, LMSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LINNEA
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:LINNEA
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:100 MICHIGAN ST NE # MC845
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:616-486-6790
Mailing Address - Fax:
Practice Address - Street 1:75 SHELDON BLVD SE
Practice Address - Street 2:STE 100
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4224
Practice Address - Country:US
Practice Address - Phone:606-391-6120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68020852951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical