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General NPI Number Information
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NPI Number | 1245919570
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Entity Type | Individual
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Provider Name | TAMAR SAMARIA DANDRIDGE LPC
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Gender | Female
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Dates
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Enumeration Date | 07/13/2023
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Last Update Date | 07/16/2023
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Provider Practice Location Address
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Address Line | 7025 HARBOUR VIEW BLVD STE 119
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City | SUFFOLK
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State | VA
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Zip | 23435-2762
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Country | US
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Telephone | 757-945-1193
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Fax |
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Provider Business Mailing Address
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Address Line | 502 FRANK LN
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-2111
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Country | US
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Telephone |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 0701011740
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701012672
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License Number State | VA
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