Provider Demographics
NPI:1669522306
Name:MITCHELL, CONSTANCE (LPC)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 LANGDON RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-3616
Mailing Address - Country:US
Mailing Address - Phone:919-889-2868
Mailing Address - Fax:919-954-7124
Practice Address - Street 1:2112 LANGDON RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-3616
Practice Address - Country:US
Practice Address - Phone:919-889-2868
Practice Address - Fax:919-954-7124
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2009-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NC3458101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102601Medicaid