Healthcare Provider Details

I. General information

NPI: 1376479352
Provider Name (Legal Business Name): TENELLE I WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5102 W VILLAGE GREEN DR STE 103
MIDLOTHIAN VA
23112-4876
US

IV. Provider business mailing address

5102 W VILLAGE GREEN DR STE 103
MIDLOTHIAN VA
23112-4876
US

V. Phone/Fax

Practice location:
  • Phone: 804-402-1151
  • Fax:
Mailing address:
  • Phone: 804-402-1151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704008133
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: