Provider Demographics
NPI:1033893631
Name:KITCHEN, TATYANA ALEXZANDRIA RHANAY (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:TATYANA
Middle Name:ALEXZANDRIA RHANAY
Last Name:KITCHEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 CLAUDIA DR
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-8318
Mailing Address - Country:US
Mailing Address - Phone:912-550-3946
Mailing Address - Fax:
Practice Address - Street 1:283 CLAUDIA DR
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-8318
Practice Address - Country:US
Practice Address - Phone:912-550-3946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15164104100000X
GAMSW10878104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker