Provider Demographics
NPI:1447071741
Name:LEWISDIXON, TASHA JULIE
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:JULIE
Last Name:LEWISDIXON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TASHA
Other - Middle Name:JULIE
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3738 E I ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98404-3030
Mailing Address - Country:US
Mailing Address - Phone:253-306-6278
Mailing Address - Fax:
Practice Address - Street 1:3738 E I ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98404-3030
Practice Address - Country:US
Practice Address - Phone:253-306-6278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101Y00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor