Provider Demographics
NPI:1043933369
Name:MITCHELL, SEAN (LCPC-C, NCC)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:LCPC-C, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 REDLON PARK RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2276
Mailing Address - Country:US
Mailing Address - Phone:207-804-0246
Mailing Address - Fax:
Practice Address - Street 1:28 REDLON PARK RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2276
Practice Address - Country:US
Practice Address - Phone:207-804-0246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL6806101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health