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General NPI Number Information
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NPI Number | 1093429177
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Entity Type | Individual
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Provider Name | T'AISYA SQUIRE
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Gender | Female
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Dates
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Enumeration Date | 01/12/2023
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Last Update Date | 01/12/2023
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Provider Practice Location Address
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Address Line | 306 TURNER RD STE L-M
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23225-6432
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Country | US
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Telephone | 804-477-2252
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Fax |
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Provider Business Mailing Address
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Address Line | 6228 RIVENDELL CT
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City | HENRICO
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State | VA
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Zip | 23231-4795
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Country | US
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Telephone | 804-539-6662
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0906013363
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License Number State | VA
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