Provider Demographics
NPI:1295922292
Name:WEAVER, TASHA DA'VETT (LPC)
Entity type:Individual
Prefix:MS
First Name:TASHA
Middle Name:DA'VETT
Last Name:WEAVER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:TASHA
Other - Middle Name:DA'VETT
Other - Last Name:HART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 3825
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71914-3825
Mailing Address - Country:US
Mailing Address - Phone:501-229-9835
Mailing Address - Fax:
Practice Address - Street 1:4 SHACKLEFORD PLZ STE 100
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-1843
Practice Address - Country:US
Practice Address - Phone:501-229-9835
Practice Address - Fax:877-552-1913
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2024-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0907046101YM0800X, 101YP2500X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR227025719Medicaid