Provider Demographics
NPI:1396256632
Name:MITCHELL, SHAKEDA
Entity type:Individual
Prefix:
First Name:SHAKEDA
Middle Name:
Last Name:MITCHELL
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 1:1013 N RIVER RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48609-6833
Mailing Address - Country:US
Mailing Address - Phone:989-596-3558
Mailing Address - Fax:989-401-7509
Practice Address - Street 1:8212 N JENNINGS RD
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:MI
Practice Address - Zip Code:48458-8248
Practice Address - Country:US
Practice Address - Phone:810-687-5100
Practice Address - Fax:810-687-0520
Is Sole Proprietor?:No
Enumeration Date:2017-10-13
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)