Provider Demographics
NPI:1699497784
Name:MITCHELL, TIFFANY SHULONDA (CADCII, ICADC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:SHULONDA
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:CADCII, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 GEORGIA AVE E UNIT 142504
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-5529
Mailing Address - Country:US
Mailing Address - Phone:678-949-0763
Mailing Address - Fax:
Practice Address - Street 1:311 WHITE INGRAM PKWY STE 500
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-0972
Practice Address - Country:US
Practice Address - Phone:678-363-7447
Practice Address - Fax:678-363-7787
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1299101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)