Provider Demographics
NPI:1518661958
Name:TECHE TAZO DATIA, ACHA
Entity Type:Individual
Prefix:
First Name:ACHA
Middle Name:
Last Name:TECHE TAZO DATIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 NEW YORK AVE NE STE 222
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-1851
Mailing Address - Country:US
Mailing Address - Phone:240-791-7863
Mailing Address - Fax:
Practice Address - Street 1:1818 NEW YORK AVE NE STE 222
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-1851
Practice Address - Country:US
Practice Address - Phone:240-791-7863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-29
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No251S00000XAgenciesCommunity/Behavioral Health