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General NPI Number Information
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NPI Number | 1861954331
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Entity Type | Individual
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Provider Name | TANISHA LAKIA NEWSOME LCAS A
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Gender | Female
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Dates
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Enumeration Date | 04/03/2019
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Last Update Date | 09/20/2025
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Provider Practice Location Address
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Address Line | 2927 FORRESTAL DR
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City | DURHAM
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State | NC
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Zip | 27703-4785
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Country | US
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Telephone | 919-519-0533
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Fax |
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Provider Business Mailing Address
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Address Line | 119 HERBERT ST
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City | DURHAM
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State | NC
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Zip | 27703-2205
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Country | US
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Telephone | 919-519-0533
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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 | 102X00000X
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Taxonomy Name | Poetry Therapist
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License Number |
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCAS-26837
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number | TN6728981
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License Number State | NC
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Taxonomy #5
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State | NC
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