Provider Demographics
NPI:1265585533
Name:MITCHELL, LINDA LEE (EDD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:LEE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 S ROAN ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-7556
Mailing Address - Country:US
Mailing Address - Phone:423-926-4357
Mailing Address - Fax:
Practice Address - Street 1:2700 S ROAN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-7556
Practice Address - Country:US
Practice Address - Phone:423-926-4357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000001739103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN188781OtherBLUECROSSBLUESHIELD