Healthcare Provider Details

I. General information

NPI: 1861954331
Provider Name (Legal Business Name): TANISHA LAKIA NEWSOME LCAS A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2927 FORRESTAL DR
DURHAM NC
27703-4785
US

IV. Provider business mailing address

2927 FORRESTAL DR
DURHAM NC
27703-4785
US

V. Phone/Fax

Practice location:
  • Phone: 919-519-0533
  • Fax:
Mailing address:
  • Phone: 919-519-0533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-26837
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code102X00000X
TaxonomyPoetry Therapist
License Number
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number129
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: