Healthcare Provider Details

I. General information

NPI: 1467984237
Provider Name (Legal Business Name): TINA WADE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2017
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 N UNION ST
ALEXANDRIA VA
22314-2657
US

IV. Provider business mailing address

43128 FLING CT
BROADLANDS VA
20148-5022
US

V. Phone/Fax

Practice location:
  • Phone: 202-281-9319
  • Fax:
Mailing address:
  • Phone: 202-281-9319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number5243
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: