Individual
TIEQUENCCIA MITCHELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
25 WOODS LAKE RD STE 506, GREENVILLE, SC 29607-2767
(864) 552-1496
(864) 370-7200
Mailing address
880 S PLEASANTBURG DR, SUITE 2E OFFICE A, GREENVILLE, SC 29607-2422
(864) 551-4244
(864) 370-7200
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
IHCP-0345
SC
253Z00000X
In Home Supportive Care Agency
Primary
IHCP-0345
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
EX1476
—
SC
01
—
IHCP-0345
DHEC
SC
Enumeration date
04/20/2016
Last updated
10/22/2019
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