Provider Demographics
NPI:1790440774
Name:TITCHENAL, TAMYRA CIRELLA
Entity Type:Individual
Prefix:
First Name:TAMYRA
Middle Name:CIRELLA
Last Name:TITCHENAL
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 1:3835 SALUDA RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-7262
Mailing Address - Country:US
Mailing Address - Phone:803-412-1911
Mailing Address - Fax:
Practice Address - Street 1:1547 CHERRY RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2616
Practice Address - Country:US
Practice Address - Phone:803-792-0771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician