Healthcare Provider Details

I. General information

NPI: 1497667612
Provider Name (Legal Business Name): VIVIAN TANNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 P ST NW STE 540
WASHINGTON DC
20036-6921
US

IV. Provider business mailing address

5203 LEESBURG PIKE # 1627
FALLS CHURCH VA
22041-3401
US

V. Phone/Fax

Practice location:
  • Phone: 202-644-8904
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGPC200012740
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: