Active NPI
David Richard Mitchell, MSW, LCSW
- Clinical Social Worker
- Chattanooga, TN
National Provider Identifier
1609882646
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149-001264
- Practice address
- 6098 Debra Rd Ste 5200
Chattanooga, TN 37411-5702 - Phone
- (423) 893-6500
- NPI assigned
- Jul 31, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149-001264 | IL | Primary |
Addresses
Primary practice location
6098 Debra Rd Ste 5200
Chattanooga, TN 37411-5702
Mailing address
2307 Mag Williams Rd
Chickamauga, GA 30707-6039
Phone (708) 476-9192
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 149-001264 | Other | IL | LCSW |
| 36-3969618 | Other | IL | FEDERAL TAX ID |
| L 2080-032716 | Other | IL | TRICARE/CHAMPUS |
| 049-72097 | Other | IL | BLUE SHIELD PROVIDER # |
| 060-006208 | Other | IL | PRO. SERVICE CORP. LIC.# |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149-001264 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1554768000000",
"number": "1609882646",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2307 MAG WILLIAMS RD",
"city": "CHICKAMAUGA",
"state": "GA",
"postal_code": "307076039",
"telephone_number": "708-476-9192"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6098 DEBRA RD STE 5200",
"city": "CHATTANOOGA",
"state": "TN",
"postal_code": "374115702",
"telephone_number": "423-893-6500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITCHELL",
"first_name": "DAVID",
"middle_name": "RICHARD",
"name_prefix": "Mr.",
"credential": "MSW, LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-31",
"last_updated": "2019-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149-001264",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LCSW",
"identifier": "149-001264",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FEDERAL TAX ID",
"identifier": "36-3969618",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE/CHAMPUS",
"identifier": "L 2080-032716",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD PROVIDER #",
"identifier": "049-72097",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRO. SERVICE CORP. LIC.#",
"identifier": "060-006208",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chattanooga, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.