Healthcare Provider Details

I. General information

NPI: 1134091861
Provider Name (Legal Business Name): TAMARA TOLLIVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2025
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 PHILADELPHIA CT
LANHAM MD
20706-4400
US

IV. Provider business mailing address

10095 WASHINGTON BLVD N APT 106
LAUREL MD
20723-1950
US

V. Phone/Fax

Practice location:
  • Phone: 301-210-4860
  • Fax:
Mailing address:
  • Phone: 347-557-4356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number33437
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: