1801375431 NPI number — TASHIA I WEEKES LCPC

Table of content: TASHIA I WEEKES LCPC (NPI 1801375431)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801375431 NPI number — TASHIA I WEEKES LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEEKES
Provider First Name:
TASHIA
Provider Middle Name:
I
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NICHOLS
Provider Other First Name:
TASHIA
Provider Other Middle Name:
I
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1801375431
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8630 FENTON STREET
Provider Second Line Business Mailing Address:
# 1204
Provider Business Mailing Address City Name:
SILVER SPRING
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-839-5811
Provider Business Mailing Address Fax Number:
301-495-0318

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CCI - COMMUNITY CLINIC INC.
Provider Second Line Business Practice Location Address:
9220 SPRINGHILL C AVE
Provider Business Practice Location Address City Name:
GREENBELT
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-624-2278
Provider Business Practice Location Address Fax Number:
301-495-0318
Provider Enumeration Date:
08/14/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LGP8898 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: LC10862 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 356018000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".