Provider Demographics
NPI:1992471098
Name:ADAMS, TANIA KRISTY (LICSW, MSW, MED)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:KRISTY
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LICSW, MSW, MED
Other - Prefix:
Other - First Name:TANIA
Other - Middle Name:ADAMS
Other - Last Name:ZIMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, MSW
Mailing Address - Street 1:1 N STADIUM WAY APT 2
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-3153
Mailing Address - Country:US
Mailing Address - Phone:808-256-3450
Mailing Address - Fax:
Practice Address - Street 1:1 N STADIUM WAY APT 2
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403-3153
Practice Address - Country:US
Practice Address - Phone:808-256-3450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW612005911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60787863OtherLCSAIW