Healthcare Provider Details

I. General information

NPI: 1679741045
Provider Name (Legal Business Name): TASHA ANDREA PRITCHETT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TASHA ANDREA FORD LCSW

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 BERKLEY HILLS PASS
EVANS GA
30809-7474
US

IV. Provider business mailing address

1222 BERKLEY HILLS PASS
EVANS GA
30809-7474
US

V. Phone/Fax

Practice location:
  • Phone: 706-312-6761
  • Fax: 762-994-1947
Mailing address:
  • Phone: 706-312-6761
  • Fax: 762-994-1947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW005614
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC 60115610
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberNC10033326
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC9626
License Number StateMS
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149030576
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberRC00049019
License Number StateWA
# 7
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11376
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: