Provider Demographics
NPI:1679322192
Name:MITCHELL, LAMONT ALLEN
Entity type:Individual
Prefix:
First Name:LAMONT
Middle Name:ALLEN
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4421 DUNHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-5906
Mailing Address - Country:US
Mailing Address - Phone:404-583-0251
Mailing Address - Fax:
Practice Address - Street 1:4421 DUNHAVEN RD
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-5906
Practice Address - Country:US
Practice Address - Phone:404-583-0251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty