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General NPI Number Information
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NPI Number | 1225919640
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Entity Type | Individual
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Provider Name | TIONNA HEREDIA M.ED
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Gender | Female
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Dates
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Enumeration Date | 09/11/2025
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1245 E MAIN ST
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City | LEBANON
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State | VA
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Zip | 24266-5016
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Country | US
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Telephone | 276-445-7090
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Fax |
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Provider Business Mailing Address
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Address Line | 102 CAMPBELL PARK DR
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City | LEBANON
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State | VA
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Zip | 24266-5233
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Country | US
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Telephone | 276-445-7090
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0704016872
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License Number State | VA
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