Provider Demographics
NPI:1831796937
Name:BUSH, JA'SHAREE TIARA (LMSW, BS, RBT)
Entity type:Individual
Prefix:
First Name:JA'SHAREE
Middle Name:TIARA
Last Name:BUSH
Suffix:
Gender:F
Credentials:LMSW, BS, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 CORPORATE CENTER DR STE C
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7376
Mailing Address - Country:US
Mailing Address - Phone:678-478-2937
Mailing Address - Fax:
Practice Address - Street 1:255 CORPORATE CENTER DR STE C
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7376
Practice Address - Country:US
Practice Address - Phone:678-478-2937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-20-130074106S00000X
GAMSW012161101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician