Provider Demographics
NPI:1881177392
Name:RICHARDSON, TANISHA (LISW)
Entity type:Individual
Prefix:
First Name:TANISHA
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 E WEST HWY APT 725
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3258
Mailing Address - Country:US
Mailing Address - Phone:614-657-8185
Mailing Address - Fax:800-905-9950
Practice Address - Street 1:3099 SULLIVANT AVE STE H
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-1800
Practice Address - Country:US
Practice Address - Phone:614-371-2303
Practice Address - Fax:800-905-9950
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1700648104100000X
OHI.21026341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0313038Medicaid