Provider Demographics
NPI:1932361581
Name:MITCHELL, LISA FAWN (LCPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:FAWN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 HUNGERFORD DR
Mailing Address - Street 2:#39
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-1713
Mailing Address - Country:US
Mailing Address - Phone:240-498-9089
Mailing Address - Fax:301-738-9901
Practice Address - Street 1:932 HUNGERFORD DR
Practice Address - Street 2:#39
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-1713
Practice Address - Country:US
Practice Address - Phone:240-498-9089
Practice Address - Fax:301-738-9901
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1005101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health