Provider Demographics
NPI:1578459905
Name:MWACHA, THERESIA
Entity type:Individual
Prefix:
First Name:THERESIA
Middle Name:
Last Name:MWACHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 HARLEY DR APT 417
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1980
Mailing Address - Country:US
Mailing Address - Phone:504-335-8233
Mailing Address - Fax:
Practice Address - Street 1:485 HARLEY DR APT 417
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43202-1980
Practice Address - Country:US
Practice Address - Phone:504-335-8233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH103K00000X, 171W00000X, 177F00000X, 347C00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171W00000XOther Service ProvidersContractor
No177F00000XOther Service ProvidersLodging
No347C00000XTransportation ServicesPrivate Vehicle