Provider Demographics
NPI:1255516688
Name:MITCHELL, TERESA ROCHELLE
Entity type:Individual
Prefix:MISS
First Name:TERESA
Middle Name:ROCHELLE
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 1:10025 LOS RANCHITOS RD
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92040-2723
Mailing Address - Country:US
Mailing Address - Phone:619-258-4012
Mailing Address - Fax:
Practice Address - Street 1:10025 LOS RANCHITOS RD
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:CA
Practice Address - Zip Code:92040-2723
Practice Address - Country:US
Practice Address - Phone:619-258-4012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health