Basic Information
| Provider Information | |||||||||
| NPI: | 1487979274 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HENRIQUES | ||||||||
| FirstName: | TANYA | ||||||||
| MiddleName: | PIILANI | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MPH, LSW, CSAC, CHES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9600 VETERANS DR | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984930001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535832834 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9600 VETERANS DR | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984930001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535832834 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2010 | ||||||||
| LastUpdateDate: | 04/05/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 943-98 | HI | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 104100000X | 1062 | HI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.