Derris Mitchell

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC004016 Issued in GA

Practice address

8303 Office Park Drive
Suite B
Douglasville, GA 30134

Phone

(678) 838-8333

NPI assigned

Jun 14, 2011

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• New Vision Counseling Center, LLC

  • Professional Counselor
  • Douglasville, GA
  • NPI 1578704250
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1308009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308009600000",
    "number": "1215222690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4031 ROCKRIDGE CT",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301357451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8303 OFFICE PARK DRIVE",
            "address_2": "SUITE B",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "30134",
            "telephone_number": "678-838-8333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "DERRIS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-06-14",
        "last_updated": "2011-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC004016",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mindful Behavioral Services LLC
• Erica Minta
• Miracle Chiropractic Rehab & Wellness
• Miraflores Eyecare, P.C.
• Mission on the Move Ministries Inc.
• Thomas Mitchell, RBT
• Neha Mithia, DMD
• ML Enrichment Services Inc.
• Sanil Saumeel Modi, MD
• Teniqua Moffatte

• Professional Counselor in Douglasville, GA
• Providers in Douglasville, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.