Provider Demographics
NPI:1942925227
Name:MITCHELL, TONYA GAIL (LMSW)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:GAIL
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 RUSK DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-8069
Mailing Address - Country:US
Mailing Address - Phone:662-614-5697
Mailing Address - Fax:
Practice Address - Street 1:499 KEYWOOD CIR STE A
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-3001
Practice Address - Country:US
Practice Address - Phone:601-387-0070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM9728104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker