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General NPI Number Information
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NPI Number | 1578116562
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Entity Type | Individual
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Provider Name | TENNILLE WOODARD MITCHELL LISW-CP, LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/19/2019
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 161 LANDMARK DR
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City | TAYLORS
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State | SC
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Zip | 29687-2819
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Country | US
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Telephone | 864-244-0154
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Fax |
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Provider Business Mailing Address
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Address Line | 415 ASPENCREEK CIR APT 303
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City | SPARTANBURG
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State | SC
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Zip | 29301-6575
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Country | US
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Telephone | 252-314-5492
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 17181
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C017844
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904017701
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License Number State | VA
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