MEDICARE: MRS. TISHA HADAWAY LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC008202	GA

General Provider Information

NPI Number	:	1427589092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TISHA HADAWAY LPC

Provider Business Mailing Address
First Line	:	423 COMANCHE TRL
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-5121
Country	:	US
Telephone Number	:	470-331-0263
Fax Number	:

Provider Business Practice Location Address
First Line	:	4002 E PONCE DE LEON AVE
Second Line	:
City	:	CLARKSTON
State	:	GA
Zip	:	30021-1815
Country	:	US
Telephone Number	:	470-331-0263
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2017
Last Update Date	:	03/24/2017

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