Provider Demographics
NPI:1982787446
Name:MITCHELL, MARY B (LCSWC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:B
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 76TH AVE
Mailing Address - Street 2:
Mailing Address - City:LANDOVER HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20784-1703
Mailing Address - Country:US
Mailing Address - Phone:301-459-2121
Mailing Address - Fax:301-459-0675
Practice Address - Street 1:5301 76TH AVE
Practice Address - Street 2:
Practice Address - City:LANDOVER HILLS
Practice Address - State:MD
Practice Address - Zip Code:20784-1703
Practice Address - Country:US
Practice Address - Phone:301-459-2121
Practice Address - Fax:301-459-0675
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD046341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical