Provider Demographics
NPI:1578116562
Name:WOODARD MITCHELL, TENNILLE (LISW-CP, LCSW)
Entity type:Individual
Prefix:
First Name:TENNILLE
Middle Name:
Last Name:WOODARD MITCHELL
Suffix:
Gender:F
Credentials:LISW-CP, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 ASPENCREEK CIR APT 303
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-6575
Mailing Address - Country:US
Mailing Address - Phone:252-314-5492
Mailing Address - Fax:
Practice Address - Street 1:161 LANDMARK DR
Practice Address - Street 2:
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-2819
Practice Address - Country:US
Practice Address - Phone:864-244-0154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC171811041C0700X
104100000X
NCC0178441041C0700X
VA09040177011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker