Provider Demographics
NPI:1437435393
Name:TISH, DONNA (MPH, LGSW)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:
Last Name:TISH
Suffix:
Gender:F
Credentials:MPH, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 CONNECTICUT AVE NW
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-1158
Mailing Address - Country:US
Mailing Address - Phone:202-624-0010
Mailing Address - Fax:202-624-0062
Practice Address - Street 1:4201 CONNECTICUT AVE NW
Practice Address - Street 2:SUITE 300
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-1158
Practice Address - Country:US
Practice Address - Phone:202-624-0010
Practice Address - Fax:202-624-0062
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG50079468104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker