Provider Demographics
NPI:1861954331
Name:NEWSOME, TANISHA LAKIA (LCAS A)
Entity type:Individual
Prefix:
First Name:TANISHA
Middle Name:LAKIA
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:LCAS A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 HERBERT ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-2205
Mailing Address - Country:US
Mailing Address - Phone:919-519-0533
Mailing Address - Fax:
Practice Address - Street 1:119 HERBERT ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-2205
Practice Address - Country:US
Practice Address - Phone:919-519-0533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
NCLCAS-268373245S0500X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children