Provider Demographics
NPI:1962909713
Name:MITCHELL BELL, JACQUELYN ELEASE (LCMHCA)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:ELEASE
Last Name:MITCHELL BELL
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9833 BELL WAY NE
Mailing Address - Street 2:
Mailing Address - City:NAVASSA
Mailing Address - State:NC
Mailing Address - Zip Code:28451-8103
Mailing Address - Country:US
Mailing Address - Phone:910-769-7210
Mailing Address - Fax:
Practice Address - Street 1:9833 BELL WAY NE
Practice Address - Street 2:
Practice Address - City:NAVASSA
Practice Address - State:NC
Practice Address - Zip Code:28451-8103
Practice Address - Country:US
Practice Address - Phone:910-769-7210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13721101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health