Provider Demographics
NPI:1205804192
Name:MITCHELL, THOMAS POLLARD (LCSW)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:POLLARD
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SANDPIPER DR
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-6987
Mailing Address - Country:US
Mailing Address - Phone:904-461-1587
Mailing Address - Fax:904-461-1587
Practice Address - Street 1:21 SANDPIPER DR
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-6987
Practice Address - Country:US
Practice Address - Phone:914-475-7204
Practice Address - Fax:904-461-1587
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW80401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical