Healthcare Provider Details

I. General information

NPI: 1376138404
Provider Name (Legal Business Name): HAWA SITAHA TANDIA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: WAHLIRA SITAHA TANDJAH LMSW

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5411 MOCKINGBIRD DR APT 315
ANCHORAGE AK
99507-1690
US

IV. Provider business mailing address

PROVIDENCE HEALTH SYSTEMS BREAKTHROUGH 3760 PIPER STREET
ANCHORAGE AK
99508
US

V. Phone/Fax

Practice location:
  • Phone: 202-417-7626
  • Fax:
Mailing address:
  • Phone: 907-212-6972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number25448
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number158419
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number25448
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number158419
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: