Provider Demographics
NPI:1780798470
Name:MITCHELL, TASHA D (LCSW)
Entity type:Individual
Prefix:MRS
First Name:TASHA
Middle Name:D
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7907 ALEXANDERS CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-4447
Mailing Address - Country:US
Mailing Address - Phone:901-288-8523
Mailing Address - Fax:662-890-4614
Practice Address - Street 1:7907 ALEXANDERS CROSSING DR
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-4447
Practice Address - Country:US
Practice Address - Phone:901-288-8523
Practice Address - Fax:662-890-4614
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC60291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02989339Medicaid