Basic Information
| Provider Information | |||||||||
| NPI: | 1811215551 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOODS | ||||||||
| FirstName: | TAMEKA | ||||||||
| MiddleName: | LASHUN | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3089 SAN JOSE DR | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300324511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6786137636 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2810 W CHARLESTON BLVD STE 70 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891021993 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252314325 | ||||||||
| FaxNumber: | 4805463134 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2010 | ||||||||
| LastUpdateDate: | 10/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFT001134 | GA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 4196-R | NV | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.