Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
Y | 101YM0800X | Mental Health Counselor | ||
N | 101YS0200X | School Counselor | ||
N | 104100000X | Social Worker |
NPI | 1225385602 |
---|---|
Provider Name | Teresa Danielle Mitchem |
First Address | Orlando, FL 32835-7642 |
Second Address | Orlando, FL 32835 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2012 |
Last Update Date | 10/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
013510800 | (05) | FL |