Provider Demographics
NPI:1396623716
Name:CAIN, TISHEKKA N
Entity type:Individual
Prefix:
First Name:TISHEKKA
Middle Name:N
Last Name:CAIN
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 1:8011 N POINT BLVD STE E2
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3244
Mailing Address - Country:US
Mailing Address - Phone:866-902-8287
Mailing Address - Fax:
Practice Address - Street 1:8011 N POINT BLVD STE E2
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3244
Practice Address - Country:US
Practice Address - Phone:866-902-8287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No172V00000XOther Service ProvidersCommunity Health Worker