Provider Demographics
NPI:1992306898
Name:MITCHELL, JENNIFER ELAINE (LLPC, CCS, CAADC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELAINE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LLPC, CCS, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3570 DEXTER ANN ARBOR RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-1619
Mailing Address - Country:US
Mailing Address - Phone:734-277-4577
Mailing Address - Fax:
Practice Address - Street 1:2311 SHELBY AVE STE 201D
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-3849
Practice Address - Country:US
Practice Address - Phone:734-277-4577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007038101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor