Individual
MR. DAVID RICHARD MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW, LCSW
Contact information
Practice address
6098 DEBRA RD STE 5200, CHATTANOOGA, TN 37411-5702
(423) 893-6500
Mailing address
2307 MAG WILLIAMS RD, CHICKAMAUGA, GA 30707-6039
(708) 476-9192
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149-001264
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
049-72097
BLUE SHIELD PROVIDER #
IL
01
—
060-006208
PRO. SERVICE CORP. LIC.#
IL
01
—
149-001264
LCSW
IL
01
—
36-3969618
FEDERAL TAX ID
IL
01
—
L 2080-032716
TRICARE/CHAMPUS
IL
Enumeration date
07/31/2006
Last updated
04/09/2019
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