Provider Demographics
NPI:1366259715
Name:DRAGONETTE, MITCHI LEE (AMFT)
Entity type:Individual
Prefix:MRS
First Name:MITCHI
Middle Name:LEE
Last Name:DRAGONETTE
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 HORIZON DR
Mailing Address - Street 2:
Mailing Address - City:SANTA YNEZ
Mailing Address - State:CA
Mailing Address - Zip Code:93460-9690
Mailing Address - Country:US
Mailing Address - Phone:805-390-7448
Mailing Address - Fax:
Practice Address - Street 1:676 PISMO ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3945
Practice Address - Country:US
Practice Address - Phone:805-543-7969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA151375106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist