Provider Demographics
NPI:1679741045
Name:PRITCHETT, TASHA ANDREA (LCSW)
Entity Type:Individual
Prefix:DR
First Name:TASHA
Middle Name:ANDREA
Last Name:PRITCHETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TASHA
Other - Middle Name:ANDREA
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2128 CIRCULAR DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-2808
Mailing Address - Country:US
Mailing Address - Phone:706-312-6761
Mailing Address - Fax:762-994-1947
Practice Address - Street 1:2128 CIRCULAR DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-2808
Practice Address - Country:US
Practice Address - Phone:253-988-7536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00049019101YM0800X
GACSW0056141041C0700X
MSC96261041C0700X
SC113761041C0700X
WANC10033326376K00000X
WASC 601156101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1861878136OtherNPI