Provider Demographics
NPI:1811648454
Name:MITCHELL, TANIKA RENAE (DOCTOR OF EDUCATION)
Entity type:Individual
Prefix:DR
First Name:TANIKA
Middle Name:RENAE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:DOCTOR OF EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5441 BOXWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:MS
Mailing Address - Zip Code:39342-9018
Mailing Address - Country:US
Mailing Address - Phone:601-917-7365
Mailing Address - Fax:
Practice Address - Street 1:5441 BOXWOOD LN
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:MS
Practice Address - Zip Code:39342-9018
Practice Address - Country:US
Practice Address - Phone:601-917-7365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL657243101Y00000X
MS185631101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty