Provider Demographics
NPI:1457556011
Name:MITCHELL, RICKY DONALD (CSAC, LPC)
Entity Type:Individual
Prefix:MR
First Name:RICKY
Middle Name:DONALD
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:CSAC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 WOODBRIAR ST.
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:VA
Mailing Address - Zip Code:24266
Mailing Address - Country:US
Mailing Address - Phone:276-971-1488
Mailing Address - Fax:276-963-3747
Practice Address - Street 1:165 GRANNYS RD
Practice Address - Street 2:
Practice Address - City:POUNDING MILL
Practice Address - State:VA
Practice Address - Zip Code:24637-4025
Practice Address - Country:US
Practice Address - Phone:276-963-3606
Practice Address - Fax:276-963-3747
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003539101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional