Provider Demographics
NPI:1063861003
Name:DENNIS, TASHUA BERRY (LICSW, LPC)
Entity Type:Individual
Prefix:
First Name:TASHUA
Middle Name:BERRY
Last Name:DENNIS
Suffix:
Gender:F
Credentials:LICSW, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 WILSON DR SW
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265-2752
Mailing Address - Country:US
Mailing Address - Phone:256-225-8769
Mailing Address - Fax:256-467-8086
Practice Address - Street 1:1316 NOBLE ST
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36201-4643
Practice Address - Country:US
Practice Address - Phone:256-236-0221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3488101YP2500X
AL5088C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional