Provider Demographics
NPI:1083507354
Name:MITCHELL, LYDIA MEREDITH (LLMSW)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:MEREDITH
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:EZRA
Other - Middle Name:LEIGH
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5716 MICHIGAN AVE STE 4100
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48210-3039
Mailing Address - Country:US
Mailing Address - Phone:313-849-2711
Mailing Address - Fax:
Practice Address - Street 1:5716 MICHIGAN AVE STE 4100
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48210-3039
Practice Address - Country:US
Practice Address - Phone:313-849-2711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851120235104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker