Provider Demographics
NPI:1487120333
Name:MITCHELL, CHELSEA F (COSMETOLOGISTS)
Entity type:Individual
Prefix:MRS
First Name:CHELSEA
Middle Name:F
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:COSMETOLOGISTS
Other - Prefix:
Other - First Name:MANE
Other - Middle Name:
Other - Last Name:ATTRACTIONS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:WIG MAKER,SELLER
Mailing Address - Street 1:12138 CENTRAL AVE # 221
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-1910
Mailing Address - Country:US
Mailing Address - Phone:703-973-9146
Mailing Address - Fax:
Practice Address - Street 1:3231 SUPERIOR LN STE A21
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1934
Practice Address - Country:US
Practice Address - Phone:703-973-7146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD442760305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service