Provider Demographics
NPI:1891524187
Name:MITCHELL, ANDREA MARLENE
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARLENE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5120 ALABAMA RD
Mailing Address - Street 2:
Mailing Address - City:APISON
Mailing Address - State:TN
Mailing Address - Zip Code:37302-9581
Mailing Address - Country:US
Mailing Address - Phone:423-355-4411
Mailing Address - Fax:
Practice Address - Street 1:5120 ALABAMA RD
Practice Address - Street 2:
Practice Address - City:APISON
Practice Address - State:TN
Practice Address - Zip Code:37302-9581
Practice Address - Country:US
Practice Address - Phone:423-355-4411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician