Healthcare Provider Details

I. General information

NPI: 1164040499
Provider Name (Legal Business Name): TIJA KRNETA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date: 04/16/2026
Reactivation Date: 05/04/2026

III. Provider practice location address

8401 MAYLAND DR # 6932
RICHMOND VA
23294-4648
US

IV. Provider business mailing address

8401 MAYLAND DR # 6932
RICHMOND VA
23294-4648
US

V. Phone/Fax

Practice location:
  • Phone: 540-280-4905
  • Fax:
Mailing address:
  • Phone: 540-280-4905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701009142
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: