Healthcare Provider Details

I. General information

NPI: 1821699828
Provider Name (Legal Business Name): TAWAKA JONES TURNER-PHILON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 STREAM VISTA PL APT 204
WALDORF MD
20601-7282
US

IV. Provider business mailing address

2230 STREAM VISTA PL APT 204
WALDORF MD
20601-7282
US

V. Phone/Fax

Practice location:
  • Phone: 256-933-0206
  • Fax:
Mailing address:
  • Phone: 256-933-0206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP10857
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC13073
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: