Provider Demographics
NPI:1376138404
Name:TANDIA, HAWA SITAHA (LMSW)
Entity Type:Individual
Prefix:
First Name:HAWA
Middle Name:SITAHA
Last Name:TANDIA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:WAHLIRA
Other - Middle Name:SITAHA
Other - Last Name:TANDJAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:PROVIDENCE HEALTH SYSTEMS BREAKTHROUGH
Mailing Address - Street 2:3760 PIPER STREET
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508
Mailing Address - Country:US
Mailing Address - Phone:907-212-6972
Mailing Address - Fax:
Practice Address - Street 1:5411 MOCKINGBIRD DR APT 315
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1690
Practice Address - Country:US
Practice Address - Phone:202-417-7626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-01
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD254481041C0700X, 104100000X
AK1584191041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
16103950OtherCAQH