Individual
CHANNON MELLISA MITCHELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
145 N PRAIRIE AVE, INGLEWOOD, CA 90301-1904
(310) 912-9274
(323) 545-3156
Mailing address
145 N PRAIRIE AVE, INGLEWOOD, CA 90301-1904
(310) 912-9274
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20202008
—
CA
Enumeration date
09/07/2021
Last updated
09/07/2021
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