Provider Demographics
NPI:1942585047
Name:MITCHELL, ANGELA DION (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:DION
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:784 WALL ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:O'FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269
Mailing Address - Country:US
Mailing Address - Phone:618-515-5158
Mailing Address - Fax:618-533-0012
Practice Address - Street 1:784 WALL ST
Practice Address - Street 2:SUITE 100
Practice Address - City:O'FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269
Practice Address - Country:US
Practice Address - Phone:618-515-5158
Practice Address - Fax:618-533-0012
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YP2500X
IL180.014052101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional