Provider Demographics
NPI:1386496297
Name:MITCHUM, CHRIS (MA, ALC)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:MITCHUM
Suffix:
Gender:M
Credentials:MA, ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 MORPHY AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-2325
Mailing Address - Country:US
Mailing Address - Phone:251-351-3071
Mailing Address - Fax:
Practice Address - Street 1:357 MORPHY AVE
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2325
Practice Address - Country:US
Practice Address - Phone:251-351-3071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04732101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health