Provider Demographics
NPI:1386312759
Name:WHEATLEY, TIA LYN MORISHIGE
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:LYN MORISHIGE
Last Name:WHEATLEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:TIA
Other - Middle Name:LYN
Other - Last Name:MORISHIGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:1700 13TH ST
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-1689
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:238 WHITE HORSE WAY
Practice Address - Street 2:
Practice Address - City:TONEY
Practice Address - State:AL
Practice Address - Zip Code:35773-4001
Practice Address - Country:US
Practice Address - Phone:256-484-5220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW615159421041C0700X
AL5758C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical