Healthcare Provider Details

I. General information

NPI: 1053165068
Provider Name (Legal Business Name): TARA PRESTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 MEADOWVIEW DR
DANVILLE VA
24541-7351
US

IV. Provider business mailing address

103 DRUID CT
DANVILLE VA
24541-4921
US

V. Phone/Fax

Practice location:
  • Phone: 434-685-1570
  • Fax: 434-685-1477
Mailing address:
  • Phone: 276-806-1995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0709025631
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: