Christina Marie Mitcham, LMSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

6801088032 Issued in MI

Practice address

40 Jefferson Ave SE
Grand Rapids, MI 49503-4304

Phone

(616) 456-1443

Fax

(616) 732-6392

NPI assigned

Jan 11, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Tina Marie Mitcham Other name

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Karen Gallagher LMSW Acsw Professional Counseling SRVS LLC

  • Clinical Social Worker
  • Okemos, MI
  • NPI 1578717245
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1294704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294704000000",
    "number": "1285939934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 JEFFERSON AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034304",
            "telephone_number": "616-456-1443",
            "fax_number": "616-732-6392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 JEFFERSON AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034304",
            "telephone_number": "616-456-1443",
            "fax_number": "616-732-6392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHAM",
        "first_name": "CHRISTINA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-01-11",
        "last_updated": "2011-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801088032",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TINA",
            "last_name": "MITCHAM",
            "middle_name": "MARIE",
            "prefix": "MRS.",
            "credential": "LMSW",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Rajnish Mishra, MD
• Lauren K Miskel
• Susan Missad, LMSW
• Mission Point of Forest Hills LLC
• Orlandria Kim Mister
• Mitchell S Vander Baan DDS, PLLC
• Abigail M Mitchell
• Ashlyn Nichole Mitchell
• Audrey M Mitchell, LMSW
• David Mitchell

• Social Worker in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.