Provider Demographics
NPI:1205079753
Name:MITCHELL, GEORGE WINSTON (LMHC)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:WINSTON
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 N DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33305-3138
Mailing Address - Country:US
Mailing Address - Phone:954-592-7891
Mailing Address - Fax:954-429-8890
Practice Address - Street 1:1621 N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33305-3138
Practice Address - Country:US
Practice Address - Phone:954-592-7891
Practice Address - Fax:954-429-8890
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1602101YA0400X
FL15597101YA0400X
FLMH7499101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)