Provider Demographics
NPI:1104901032
Name:ARENDASH, TINA (LCSW)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:ARENDASH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 SYCAMORE DR
Mailing Address - Street 2:
Mailing Address - City:DRUMS
Mailing Address - State:PA
Mailing Address - Zip Code:18222-2049
Mailing Address - Country:US
Mailing Address - Phone:570-599-5918
Mailing Address - Fax:
Practice Address - Street 1:179 S WYOMING AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-3405
Practice Address - Country:US
Practice Address - Phone:570-285-8025
Practice Address - Fax:570-696-4361
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0190921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical