Provider Demographics
NPI:1720487556
Name:MITCHELL, CIARA MARIA (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:CIARA
Middle Name:MARIA
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3276 CAHABA MANOR DR
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-3183
Mailing Address - Country:US
Mailing Address - Phone:404-788-2266
Mailing Address - Fax:
Practice Address - Street 1:3276 CAHABA MANOR DR
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-3183
Practice Address - Country:US
Practice Address - Phone:404-788-2266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2220133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered