Provider Demographics
NPI:1386455293
Name:MITCHELL, PATRIC LEE (CADC)
Entity type:Individual
Prefix:
First Name:PATRIC
Middle Name:LEE
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MINGOCREST DR
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-7667
Mailing Address - Country:US
Mailing Address - Phone:919-999-6685
Mailing Address - Fax:
Practice Address - Street 1:10520 LIGON MILL RD STE 100A
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-4586
Practice Address - Country:US
Practice Address - Phone:919-330-3840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCADC-21179101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)