Provider Demographics
NPI:1285471896
Name:MITCHEM, SARAH DANIELLE
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:DANIELLE
Last Name:MITCHEM
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 1:506 JEFFERSONVILLE ST
Mailing Address - Street 2:
Mailing Address - City:TAZEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:24651-5396
Mailing Address - Country:US
Mailing Address - Phone:276-988-5511
Mailing Address - Fax:
Practice Address - Street 1:167 COSBY LN
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:VA
Practice Address - Zip Code:24651-2500
Practice Address - Country:US
Practice Address - Phone:276-970-4964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool