Individual
DORIS MITNICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
601 CHILDRENS LN, 4TH FLOOR, SOCIAL WORK DEPT, NORFOLK, VA 23507-1910
(757) 668-7937
(757) 668-7950
Mailing address
3301 TROTMAN WHARF DR, SUFFOLK, VA 23435-1063
(757) 923-1983
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0904003641
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
217871
ANTHEM
VA
05
—
89-50156
—
VA
01
—
O83200M
SENTARA
VA
Enumeration date
07/10/2006
Last updated
07/09/2007
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