Provider Demographics
NPI:1891050936
Name:MITCHELL, KAREN (MSW)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1323 S SHANGRI LA DR
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32119-1502
Mailing Address - Country:US
Mailing Address - Phone:386-320-3305
Mailing Address - Fax:
Practice Address - Street 1:1323 S SHANGRI LA DR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32119-1502
Practice Address - Country:US
Practice Address - Phone:386-320-3305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-04
Last Update Date:2012-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker