Healthcare Provider Details

I. General information

NPI: 1821907999
Provider Name (Legal Business Name): TIYANA BARNES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 SPRUCE ST
SUFFOLK VA
23434-4622
US

IV. Provider business mailing address

219 SPRUCE ST
SUFFOLK VA
23434-4622
US

V. Phone/Fax

Practice location:
  • Phone: 757-541-4599
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0784019435
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: