Provider Demographics
NPI:1750749776
Name:DUDLEY-MITCHELL, ERIN (LPC, NCC)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:DUDLEY-MITCHELL
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 SMITHVILLE CHURCH RD STE B
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-6486
Mailing Address - Country:US
Mailing Address - Phone:478-225-4886
Mailing Address - Fax:
Practice Address - Street 1:239 SMITHVILLE CHURCH RD STE B
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-6486
Practice Address - Country:US
Practice Address - Phone:478-225-4886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008204101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional