Provider Demographics
NPI:1568293561
Name:TITTSWORTH, MIKAYLA ASHLYN (LCMHCA)
Entity type:Individual
Prefix:MS
First Name:MIKAYLA
Middle Name:ASHLYN
Last Name:TITTSWORTH
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3603 WEBSTER WAY APT 1607
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-3825
Mailing Address - Country:US
Mailing Address - Phone:276-698-1609
Mailing Address - Fax:
Practice Address - Street 1:1437 MILITARY CUTOFF RD STE 210
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-3638
Practice Address - Country:US
Practice Address - Phone:910-240-3392
Practice Address - Fax:910-447-4421
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20369101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty