Basic Information
| Provider Information | |||||||||
| NPI: | 1427394931 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MITCHELL | ||||||||
| FirstName: | ANITA | ||||||||
| MiddleName: | RENISE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | BA., SST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 175 N GROESBECK HWY | ||||||||
| Address2: | |||||||||
| City: | MOUNT CLEMENS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480431562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5869145573 | ||||||||
| FaxNumber: | 5866270027 | ||||||||
| Practice Location | |||||||||
| Address1: | 175 N GROESBECK HWY | ||||||||
| Address2: | |||||||||
| City: | MOUNT CLEMENS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480431562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5869145573 | ||||||||
| FaxNumber: | 5866270027 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2013 | ||||||||
| LastUpdateDate: | 01/02/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6803085755 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.