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General NPI Number Information
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NPI Number | 1649138553
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Entity Type | Individual
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Provider Name | OLIVIA R TISA LGSW
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Gender | Female
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Dates
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Enumeration Date | 01/12/2026
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 4400 MACARTHUR BLVD NW STE 300
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City | WASHINGTON
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State | DC
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Zip | 20007-2521
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Country | US
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Telephone | 202-455-8440
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Fax |
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Provider Business Mailing Address
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Address Line | 2425 17TH ST NW APT 21
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City | WASHINGTON
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State | DC
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Zip | 20009-2798
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Country | US
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Telephone | 708-846-0478
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LG200002837
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License Number State | DC
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