Provider Demographics
NPI:1487244604
Name:LEWIS, TASHA LORRAINE (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:LORRAINE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 SHEERER DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-7692
Mailing Address - Country:US
Mailing Address - Phone:304-886-2043
Mailing Address - Fax:
Practice Address - Street 1:348 SHEERER DR
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-7692
Practice Address - Country:US
Practice Address - Phone:304-886-2043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-20-45268103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst