Individual
TERESA DANIELLE MITCHEM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
414 LAKE HOWELL RD, MAITLAND, FL 32751-5900
(407) 637-2633
Mailing address
414 LAKE HOWELL RD, MAITLAND, FL 32751-5900
(407) 637-2633
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YS0200X
School Counselor
—
—
104100000X
Social Worker
—
—
222Q00000X
Developmental Therapist
—
—
251B00000X
Case Management Agency
Primary
100523
FL
251B00000X
Case Management Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
013510800
—
FL
05
—
105479600
—
FL
Enumeration date
08/05/2012
Last updated
09/09/2022
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