Provider Demographics
NPI:1639370075
Name:MITCHELL, KISHA RENEE (BS)
Entity Type:Individual
Prefix:
First Name:KISHA
Middle Name:RENEE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 COFFEE ST SW
Mailing Address - Street 2:APT 134
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265-2523
Mailing Address - Country:US
Mailing Address - Phone:205-307-9292
Mailing Address - Fax:
Practice Address - Street 1:1200 NOBLE ST
Practice Address - Street 2:SUITE 120
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36201-4659
Practice Address - Country:US
Practice Address - Phone:256-741-6165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor