Healthcare Provider Details

I. General information

NPI: 1851882963
Provider Name (Legal Business Name): TANYA VENISA MONCRIEFFE-HEATH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 05/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 WASHINGTON BLVD FL 3
ARLINGTON VA
22204-5717
US

IV. Provider business mailing address

1075 S JEFFERSON ST APT 222
ARLINGTON VA
22204-3121
US

V. Phone/Fax

Practice location:
  • Phone: 703-228-5905
  • Fax:
Mailing address:
  • Phone: 910-286-9550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberPPS-0605478
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: