Provider Demographics
NPI:1205485703
Name:MITCHELL, CHARON STEPHAINE
Entity type:Individual
Prefix:MRS
First Name:CHARON
Middle Name:STEPHAINE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHARON
Other - Middle Name:STEPHAINE
Other - Last Name:DE LEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15405 LANSDOWNE RD STE D
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-0201
Mailing Address - Country:US
Mailing Address - Phone:714-429-6834
Mailing Address - Fax:
Practice Address - Street 1:15405 LANSDOWNE RD STE D
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-0201
Practice Address - Country:US
Practice Address - Phone:714-429-6834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor