Healthcare Provider Details

I. General information

NPI: 1942614847
Provider Name (Legal Business Name): TANISHA EVERETT LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 N CHARLES ST
BALTIMORE MD
21218-5778
US

IV. Provider business mailing address

849 FAIRMOUNT AVE FL 5
TOWSON MD
21286-2624
US

V. Phone/Fax

Practice location:
  • Phone: 410-453-9553
  • Fax:
Mailing address:
  • Phone: 443-377-5273
  • Fax: 443-659-2429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number25298
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: