Provider Demographics
NPI:1871462143
Name:MITCHELL, TANESHA LARSHINE (LCSWA)
Entity type:Individual
Prefix:
First Name:TANESHA
Middle Name:LARSHINE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3491 EVANS ST STE A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-4534
Mailing Address - Country:US
Mailing Address - Phone:252-364-2321
Mailing Address - Fax:844-272-4550
Practice Address - Street 1:3491 EVANS ST STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-4534
Practice Address - Country:US
Practice Address - Phone:252-364-2321
Practice Address - Fax:844-272-4550
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-04
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0231391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical