Provider Demographics
NPI:1790538122
Name:PELHAM, TANISHA (PHD)
Entity Type:Individual
Prefix:
First Name:TANISHA
Middle Name:
Last Name:PELHAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 COMMERCE LN APT 708
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-6263
Mailing Address - Country:US
Mailing Address - Phone:863-444-1467
Mailing Address - Fax:
Practice Address - Street 1:1350 CONNECTICUT AVE NW STE 500
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-1736
Practice Address - Country:US
Practice Address - Phone:969-227-4202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSYA200001417103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling