Healthcare Provider Details

I. General information

NPI: 1396623716
Provider Name (Legal Business Name): TISHEKKA N CAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 DALTON RD
MOCKSVILLE NC
27028-5117
US

IV. Provider business mailing address

8011 N POINT BLVD STE E2
WINSTON SALEM NC
27106-3244
US

V. Phone/Fax

Practice location:
  • Phone: 336-941-8121
  • Fax:
Mailing address:
  • Phone: 866-902-8287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: