Healthcare Provider Details

I. General information

NPI: 1013487396
Provider Name (Legal Business Name): TANIKIA WASHINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2018
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2313 RED TIDE RD
VIRGINIA BEACH VA
23451-1203
US

IV. Provider business mailing address

2313 RED TIDE RD UNIT 1
VIRGINIA BEACH VA
23451-1203
US

V. Phone/Fax

Practice location:
  • Phone: 910-703-2848
  • Fax:
Mailing address:
  • Phone: 757-574-1384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701014837
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: