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General NPI Number Information
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NPI Number | 1548372311
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Entity Type | Individual
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Provider Name | TARA ANN MITCHELL PH.D.
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 09/24/2025
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Provider Practice Location Address
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Address Line | 4348 ELECTRIC RD
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City | ROANOKE
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State | VA
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Zip | 24018-0720
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Country | US
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Telephone | 540-769-0976
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Fax | 540-857-5385
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Provider Business Mailing Address
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Address Line | 213 S JEFFERSON ST STE 1006
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City | ROANOKE
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State | VA
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Zip | 24011-1713
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810004242
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License Number State | VA
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