Provider Demographics
NPI:1265983290
Name:MITCHELL, ALISON S (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:ALISON
Middle Name:S
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ORONO
Mailing Address - State:ME
Mailing Address - Zip Code:04473-3802
Mailing Address - Country:US
Mailing Address - Phone:207-356-6418
Mailing Address - Fax:
Practice Address - Street 1:61 MAIN ST STE 60
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6469
Practice Address - Country:US
Practice Address - Phone:207-356-6418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-14
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC16038104100000X
MELC172061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker