Provider Demographics
NPI:1508943234
Name:DARLAND, TISHA (LSCSW)
Entity Type:Individual
Prefix:
First Name:TISHA
Middle Name:
Last Name:DARLAND
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:TISHA
Other - Middle Name:
Other - Last Name:BIRMINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:7807 E FUNSTON ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-3123
Mailing Address - Country:US
Mailing Address - Phone:316-636-1188
Mailing Address - Fax:316-636-1199
Practice Address - Street 1:7807 E FUNSTON ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-3123
Practice Address - Country:US
Practice Address - Phone:316-636-1188
Practice Address - Fax:316-636-1199
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4862104100000X
1041C0700X
KS43901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker