Provider Demographics
NPI:1356161525
Name:MITCHELL, DESTINY (LMHP-S)
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LMHP-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 TERRYS MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-6563
Mailing Address - Country:US
Mailing Address - Phone:276-806-4186
Mailing Address - Fax:
Practice Address - Street 1:190 TERRYS MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-6563
Practice Address - Country:US
Practice Address - Phone:276-806-4186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09060127691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical