Provider Demographics
NPI:1689984700
Name:MITCHELL, DORIAN JAMES (MS, LBS)
Entity type:Individual
Prefix:MR
First Name:DORIAN
Middle Name:JAMES
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MS, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BALA AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-3163
Mailing Address - Country:US
Mailing Address - Phone:484-410-6803
Mailing Address - Fax:610-672-9629
Practice Address - Street 1:12 BALA AVE APT 2
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3163
Practice Address - Country:US
Practice Address - Phone:484-410-6803
Practice Address - Fax:610-672-9629
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-08
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
PABH002112103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health