Provider Demographics
NPI:1235523929
Name:EARLE, TAMIKA LASHAWNA (LMSW)
Entity Type:Individual
Prefix:
First Name:TAMIKA
Middle Name:LASHAWNA
Last Name:EARLE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 BICKFORD CIR
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29625-6915
Mailing Address - Country:US
Mailing Address - Phone:864-376-0425
Mailing Address - Fax:
Practice Address - Street 1:1039 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:SC
Practice Address - Zip Code:29670-9476
Practice Address - Country:US
Practice Address - Phone:864-376-0425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-20
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
SC14380104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst