Provider Demographics
NPI:1811441025
Name:MITCHELL, ALONZO JR
Entity type:Individual
Prefix:
First Name:ALONZO
Middle Name:
Last Name:MITCHELL
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 DANIEL WEBSTER DR
Mailing Address - Street 2:APT A
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-6514
Mailing Address - Country:US
Mailing Address - Phone:407-283-4351
Mailing Address - Fax:
Practice Address - Street 1:7401 DANIEL WEBSTER DR
Practice Address - Street 2:APT A
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-6514
Practice Address - Country:US
Practice Address - Phone:407-283-4351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker