Provider Demographics
NPI:1932444106
Name:MITCHELL-YOUNG, LADORTHA J (MSW LCSW)
Entity type:Individual
Prefix:
First Name:LADORTHA
Middle Name:J
Last Name:MITCHELL-YOUNG
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4942 ALLISONVILLE RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-1538
Mailing Address - Country:US
Mailing Address - Phone:317-550-6229
Mailing Address - Fax:
Practice Address - Street 1:3921 N MERIDIAN ST STE 102
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-4061
Practice Address - Country:US
Practice Address - Phone:317-252-5258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99072042A104100000X
IN34009677A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker