Provider Demographics
NPI:1679972111
Name:TARVER, MITCHELL (LCSW)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:TARVER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:MITCHELL
Other - Middle Name:
Other - Last Name:TARVER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:205 COUNTY ROAD 134
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:AL
Mailing Address - Zip Code:35033-3061
Mailing Address - Country:US
Mailing Address - Phone:205-876-6028
Mailing Address - Fax:
Practice Address - Street 1:205 COUNTY ROAD 134
Practice Address - Street 2:
Practice Address - City:BREMEN
Practice Address - State:AL
Practice Address - Zip Code:35033-3061
Practice Address - Country:US
Practice Address - Phone:205-876-6028
Practice Address - Fax:205-668-0894
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3601C101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)