Healthcare Provider Details

I. General information

NPI: 1992104038
Provider Name (Legal Business Name): TEANNA DIGGS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 05/02/2020
Certification Date: 05/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6593 CORBEL WAY
FREDERICK MD
21703-2753
US

IV. Provider business mailing address

3375 S HOOVER ST SUITE H201
LOS ANGELES CA
90089-0116
US

V. Phone/Fax

Practice location:
  • Phone: 703-772-5097
  • Fax:
Mailing address:
  • Phone: 213-821-5977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22508
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: