Provider Demographics
NPI:1427343847
Name:MITCHELL, NICOLE (LSW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 N 11TH ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-2211
Mailing Address - Country:US
Mailing Address - Phone:484-661-0990
Mailing Address - Fax:
Practice Address - Street 1:3295 FOREST INN RD
Practice Address - Street 2:
Practice Address - City:PALMERTON
Practice Address - State:PA
Practice Address - Zip Code:18071-5467
Practice Address - Country:US
Practice Address - Phone:610-826-8482
Practice Address - Fax:610-826-8483
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker