Provider Demographics
NPI:1154893451
Name:TYEHIMBA, AISHA (LGPC)
Entity type:Individual
Prefix:
First Name:AISHA
Middle Name:
Last Name:TYEHIMBA
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 I ST NW STE 400E
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20005-3318
Mailing Address - Country:US
Mailing Address - Phone:202-294-8049
Mailing Address - Fax:
Practice Address - Street 1:1300 I ST NW STE 400E
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-3318
Practice Address - Country:US
Practice Address - Phone:301-804-8279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLGPC00240101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health