Provider Demographics
NPI:1720272099
Name:MITCHELL, SUSAN NICHOLS (LPC)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:NICHOLS
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:NICHOLS
Other - Last Name:SHEPARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1401 20TH ST S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-4913
Mailing Address - Country:US
Mailing Address - Phone:205-510-2761
Mailing Address - Fax:205-510-2790
Practice Address - Street 1:333 BUSINESS CIR
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-1778
Practice Address - Country:US
Practice Address - Phone:205-510-2761
Practice Address - Fax:205-510-2790
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1881101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51545131OtherBLUE CROSS BLUE SHIELD