Individual
RUSSELL GEORGE MITCHELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
26522 VAN DYKE AVE, CENTER LINE, MI 48015-1221
(586) 759-4400
Mailing address
6549 TOWN CENTER DR, STE. A, CLARKSTON, MI 48346-4824
(248) 620-6400
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6401012311
MI
104100000X
Social Worker
6802073208
MI
Other
Enumeration date
06/26/2007
Last updated
11/17/2016
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