Provider Demographics
NPI:1174655690
Name:TANZA HASKINS COUNSELING SERVICES, INC.
Entity Type:Organization
Organization Name:TANZA HASKINS COUNSELING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANZA
Authorized Official - Middle Name:G
Authorized Official - Last Name:HASKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:919-839-0042
Mailing Address - Street 1:PO BOX 46180
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27620-6180
Mailing Address - Country:US
Mailing Address - Phone:919-839-0042
Mailing Address - Fax:919-821-1434
Practice Address - Street 1:871 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-1255
Practice Address - Country:US
Practice Address - Phone:919-839-0042
Practice Address - Fax:919-821-1434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0026801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002839Medicaid