Basic Information
| Provider Information | |||||||||
| NPI: | 1679854384 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PERINE-DIXON | ||||||||
| FirstName: | TANISHA | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 E MCMILLAN ST | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452061922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132213350 | ||||||||
| FaxNumber: | 5139480087 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 E MCMILLAN ST | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452061922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132213350 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2011 | ||||||||
| LastUpdateDate: | 08/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | C.1000454 | OH | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YA0400X | 110327 | OH | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | E.2001829 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.