Provider Demographics
NPI:1316816341
Name:MITCHELL, CAROL CARSON (LCAS-A)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:CARSON
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 CHERRY LAUREL DR APT 104
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-0050
Mailing Address - Country:US
Mailing Address - Phone:704-615-4202
Mailing Address - Fax:
Practice Address - Street 1:809 CHERRY LAUREL DR APT 104
Practice Address - Street 2:APT 104
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-0050
Practice Address - Country:US
Practice Address - Phone:704-615-4202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-29
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-30496101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty