Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 2-01173 | MI |
Y | 104100000X | Social Worker | 6801093133 | MI |
N | 1041C0700X | Clinical Social Worker | 6801093133 | MI |
NPI | 1003164245 |
---|---|
Provider Name | Mr. Nicholas James Mitchell |
First Address | Howell, MI 48843-2329 |
Second Address | Brighton, MI 48116-9558 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2012 |
Last Update Date | 16/10/2019 |