Provider Demographics
NPI:1427743970
Name:MITCHELL, JODIE SUE (LPC)
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:SUE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:PA
Mailing Address - Zip Code:17517-9344
Mailing Address - Country:US
Mailing Address - Phone:484-599-0188
Mailing Address - Fax:
Practice Address - Street 1:20 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:PA
Practice Address - Zip Code:17517-1610
Practice Address - Country:US
Practice Address - Phone:717-875-1655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC015386101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional