Tiffany Shulonda Mitchell, CADCII, ICADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

1299 Issued in GA

Practice address

311 White Ingram Pkwy Ste 500
Dallas, GA 30132-0972

Phone

(678) 363-7447

Fax

(678) 363-7787

NPI assigned

Sep 15, 2022

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1663200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663200000000",
    "number": "1699497784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 GEORGIA AVE E UNIT 142504",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302145529",
            "telephone_number": "678-949-0763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 WHITE INGRAM PKWY STE 500",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301320972",
            "telephone_number": "678-363-7447",
            "fax_number": "678-363-7787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "TIFFANY",
        "middle_name": "SHULONDA",
        "credential": "CADCII, ICADC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-09-15",
        "last_updated": "2022-09-15",
        "certification_date": "2022-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "GA",
            "license": "1299",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Keith Miller, PHARMD
• Mary Kea Miller, SLP
• Katie Blalock Mills, PHARMD
• Caroline Mitchell
• Kamarie Dylanna-Makela Mitchell
• Briana Mizrahi
• Shem Mobisa
• Momentum Behavioral Services
• Farhan Abbas Momin, DMD
• Mohammad Mehdi Momtahan, PH.D.

• Addiction (Substance Use Disorder) Counselor in Dallas, GA
• Providers in Dallas, GA by specialty
• Addiction (Substance Use Disorder) Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.