Provider Demographics
NPI:1235609421
Name:MITCHELL, TIANA DENAE
Entity Type:Individual
Prefix:
First Name:TIANA
Middle Name:DENAE
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 1:420 E 43RD ST
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-5476
Mailing Address - Country:US
Mailing Address - Phone:440-506-2155
Mailing Address - Fax:
Practice Address - Street 1:420 E 43RD ST
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-5476
Practice Address - Country:US
Practice Address - Phone:440-506-2155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator