Provider Demographics
NPI:1447634290
Name:MITCHELL, COLLEEN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5490 MCGINNIS VILLAGE PL
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-1733
Mailing Address - Country:US
Mailing Address - Phone:404-271-5104
Mailing Address - Fax:
Practice Address - Street 1:5490 MCGINNIS VILLAGE PL
Practice Address - Street 2:SUITE 205
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-1733
Practice Address - Country:US
Practice Address - Phone:404-271-5104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALCSW 0016371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical