Provider Demographics
NPI:1326489428
Name:PENICHE, TASHA TENIKA
Entity Type:Individual
Prefix:MRS
First Name:TASHA
Middle Name:TENIKA
Last Name:PENICHE
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 1:111 W HIGH ST STE 109
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-5549
Mailing Address - Country:US
Mailing Address - Phone:410-273-4448
Mailing Address - Fax:
Practice Address - Street 1:111 W HIGH ST STE 109
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5549
Practice Address - Country:US
Practice Address - Phone:443-760-3620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health