Provider Demographics
NPI:1801375431
Name:WEEKES, TASHIA I (LCPC)
Entity Type:Individual
Prefix:
First Name:TASHIA
Middle Name:I
Last Name:WEEKES
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:TASHIA
Other - Middle Name:I
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:8630 FENTON STREET
Mailing Address - Street 2:# 1204
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910
Mailing Address - Country:US
Mailing Address - Phone:240-839-5811
Mailing Address - Fax:301-495-0318
Practice Address - Street 1:CCI - COMMUNITY CLINIC INC.
Practice Address - Street 2:9220 SPRINGHILL C AVE
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770
Practice Address - Country:US
Practice Address - Phone:240-624-2278
Practice Address - Fax:301-495-0318
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP8898101YP2500X
MDLC10862101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD356018000Medicaid