Provider Demographics
NPI:1184751604
Name:MITCHELL, COLLEEN DENISE (PHD)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:DENISE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 TURBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-2009
Mailing Address - Country:US
Mailing Address - Phone:301-890-0214
Mailing Address - Fax:301-890-0214
Practice Address - Street 1:8101 SANDY SPRING RD
Practice Address - Street 2:SUITE 100F
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-3596
Practice Address - Country:US
Practice Address - Phone:951-536-3682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000002884103TC0700X
MD05644103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical