Provider Demographics
NPI:1538699368
Name:GORDON-ADAMS, TYSHA
Entity Type:Individual
Prefix:
First Name:TYSHA
Middle Name:
Last Name:GORDON-ADAMS
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 1:1268 ROCKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-2922
Mailing Address - Country:US
Mailing Address - Phone:508-492-9916
Mailing Address - Fax:
Practice Address - Street 1:1268 ROCKDALE AVE
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-2922
Practice Address - Country:US
Practice Address - Phone:508-492-9916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22441101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)