Provider Demographics
NPI:1700130622
Name:MITCHELL, PHILIP S (LAPC)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:S
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2699
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-1384
Mailing Address - Country:US
Mailing Address - Phone:678-391-5950
Mailing Address - Fax:678-391-5969
Practice Address - Street 1:5345 CROSSROADS DRIVE
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30102-2536
Practice Address - Country:US
Practice Address - Phone:678-391-5950
Practice Address - Fax:678-391-5969
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)