Provider Demographics
NPI:1194254276
Name:MITCHELL, KATHRYN AUGUSTE (LCPC, CADC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:AUGUSTE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 VINCENT ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-3951
Mailing Address - Country:US
Mailing Address - Phone:603-660-2369
Mailing Address - Fax:
Practice Address - Street 1:306 SHAKER RD
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:ME
Practice Address - Zip Code:04039-9674
Practice Address - Country:US
Practice Address - Phone:603-660-2369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC5275101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional