Provider Demographics
NPI:1154420214
Name:BERRY-MITCHELL, FELICIA L (PHD)
Entity type:Individual
Prefix:DR
First Name:FELICIA
Middle Name:L
Last Name:BERRY-MITCHELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:FELICIA
Other - Middle Name:L
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 5464
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30154-0008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3400 CHAPEL HILL RD
Practice Address - Street 2:SUITE 100 PMB #08
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1739
Practice Address - Country:US
Practice Address - Phone:678-996-8857
Practice Address - Fax:678-391-8788
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003237103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist