Provider Information for 1962929695
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SELETHIA LINDA MITCHELL LCSW
Sex: Female
NPI: 1962929695
Last Updated: 2022-07-21
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1962929695 | ||||||||
| Enumeration Date | 2017-08-24 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 5871 W COCHISE DR GLENDALE, AZ 85302-1355 United States Phone: 602-488-9900 | Fax: | ||||||||
| Primary Practice Address | 6601 W THOMAS RD PHOENIX, AZ 85033-5700 United States Phone: 602-243-7277 | Fax:623-247-9742 | ||||||||
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