Provider Demographics
NPI:1124346150
Name:MITCHELL, ADRIENNE CHANEL
Entity type:Individual
Prefix:MS
First Name:ADRIENNE
Middle Name:CHANEL
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6955 FOOTHILL BLVD FL 3
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-2455
Mailing Address - Country:US
Mailing Address - Phone:510-577-1905
Mailing Address - Fax:510-577-5619
Practice Address - Street 1:24085 AMADOR ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-1222
Practice Address - Country:US
Practice Address - Phone:510-670-6286
Practice Address - Fax:510-670-6444
Is Sole Proprietor?:No
Enumeration Date:2010-05-14
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator