Provider Demographics
NPI:1831362565
Name:MITCHELL, SHARON M (MS, LMHC)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:M
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MS, LMHC
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 4019
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33509-4019
Mailing Address - Country:US
Mailing Address - Phone:813-957-0419
Mailing Address - Fax:
Practice Address - Street 1:150 E BLOOMINGDALE AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8151
Practice Address - Country:US
Practice Address - Phone:813-957-0419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6307101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH6307OtherBLUE CROSS BLUE SHIELD