Healthcare Provider Details

I. General information

NPI: 1326802646
Provider Name (Legal Business Name): TANISHA HUMPHREY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2024
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10770 COLUMBIA PIKE STE 300
SILVER SPRING MD
20901-4439
US

IV. Provider business mailing address

2300 PENNSYLVANIA AVE UNIT LLC
WILMINGTON DE
19806-1392
US

V. Phone/Fax

Practice location:
  • Phone: 302-213-6158
  • Fax: 855-530-2764
Mailing address:
  • Phone: 302-213-6158
  • Fax: 855-530-2764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL07090500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number32886
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-0012796
License Number StateDE
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberQ3-0011277
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: