Provider Demographics
NPI:1124681861
Name:MITCHELL, DONNA (LCPC)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
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 1:12510 PROSPERITY DR STE 180
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1695
Mailing Address - Country:US
Mailing Address - Phone:301-650-5940
Mailing Address - Fax:
Practice Address - Street 1:12510 PROSPERITY DR STE 180
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1695
Practice Address - Country:US
Practice Address - Phone:301-650-5940
Practice Address - Fax:240-465-0070
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-18
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC8808101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLC8808OtherLICENSE