Provider Demographics
NPI:1548372311
Name:MITCHELL, TARA ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:ANN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:TARA
Other - Middle Name:ANN
Other - Last Name:REYNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4348 ELECTRIC RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-0720
Practice Address - Country:US
Practice Address - Phone:540-769-0976
Practice Address - Fax:540-857-5385
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004242103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical