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:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 352
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24212-0352
Mailing Address - Country:US
Mailing Address - Phone:276-254-5445
Mailing Address - Fax:276-206-8045
Practice Address - Street 1:261 NORTH ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-3275
Practice Address - Country:US
Practice Address - Phone:276-254-5445
Practice Address - Fax:276-208-8045
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003539101YA0400X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010072107Medicaid