Provider Demographics
NPI:1215427117
Name:MITCHELL, ALLISON ANNE
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:ANNE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 5TH ST N APT A3
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-4358
Mailing Address - Country:US
Mailing Address - Phone:561-294-2663
Mailing Address - Fax:
Practice Address - Street 1:4224 28TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33714-3922
Practice Address - Country:US
Practice Address - Phone:727-544-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician