Provider Demographics
NPI:1073355111
Name:MITCHELL, TERRY C II (MS)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:C
Last Name:MITCHELL
Suffix:II
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1179 BERKSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:INDIAN ORCHARD
Mailing Address - State:MA
Mailing Address - Zip Code:01151-1359
Mailing Address - Country:US
Mailing Address - Phone:413-204-1700
Mailing Address - Fax:
Practice Address - Street 1:1179 BERKSHIRE AVE
Practice Address - Street 2:
Practice Address - City:INDIAN ORCHARD
Practice Address - State:MA
Practice Address - Zip Code:01151-1359
Practice Address - Country:US
Practice Address - Phone:413-204-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)