Provider Demographics
NPI:1174293112
Name:MITCHELL, SHAMERIKA
Entity Type:Individual
Prefix:
First Name:SHAMERIKA
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 RAYNOR DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-7403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:291 INDEPENDENCE BLVD STE 532
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-5473
Practice Address - Country:US
Practice Address - Phone:757-962-6889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2023-10-25
Deactivation Date:2021-10-08
Deactivation Code:
Reactivation Date:2023-10-25
Provider Licenses
StateLicense IDTaxonomies
VA0704013770101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health