Pamela June Dixon Mitchell, PHD
Individual provider Active NPI Clinical Psychologist · Boyds, MD
NPI 1255666236 · NPPES record last updated Jun 18, 2025
Key facts
- NPI
- 1255666236
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 6301011420 (MI)
- Practice address
- 12937 Ethel Rose Way
Boyds, MD 20841-2010 - Phone
- (419) 344-4880
- NPI assigned
- Oct 9, 2009
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301011420 | MI | MD | Clinical Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6301011420 | MI | Yes |
Addresses
Primary practice location
12937 Ethel Rose Way
Boyds, MD 20841-2010
Mailing address
12937 Ethel Rose Way
Boyds, MD 20841-2010
Phone (734) 936-2047
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All providers in Boyds, MD · Clinical Psychologist in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 18, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.