Individual
MRS. TAKEISHA MITCHELL-INGRAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
130 S INDIAN RIVER DR STE 202, FORT PIERCE, FL 34950-4353
(772) 905-9030
Mailing address
1778 SW NEWPORT ISLES BLVD, PORT ST LUCIE, FL 34953-4590
(561) 818-1101
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Enumeration date
08/22/2017
Last updated
08/22/2017
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