Provider Demographics
NPI:1457909582
Name:MITCHELL, HEATHER (LSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15636 HENRY RD
Mailing Address - Street 2:
Mailing Address - City:AMESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45711-9514
Mailing Address - Country:US
Mailing Address - Phone:214-502-8035
Mailing Address - Fax:
Practice Address - Street 1:8680 ROCK RIFFLE RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-9656
Practice Address - Country:US
Practice Address - Phone:214-502-8035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-02
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1904188104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker