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General NPI Number Information
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NPI Number | 1285182246
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Entity Type | Organization
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Legal Business Name | TANIKKA MASON
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Dates
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Enumeration Date | 09/19/2016
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Last Update Date | 09/19/2016
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Provider Practice Location Address
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Address Line | 2002 WAKEFIELD AVE
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City | PETERSBURG
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State | VA
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Zip | 23805-2112
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Country | US
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Telephone | 804-733-1180
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Fax | 804-733-1181
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Provider Business Mailing Address
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Address Line | 2002 WAKEFIELD AVE
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City | PETERSBURG
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State | VA
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Zip | 23805-2112
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Country | US
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Telephone | 804-733-1180
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Fax | 804-733-1181
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Authorized Official
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Title or Position | CHIEF CLINICAL OFFICER
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Name | MRS. TANIKKA LASHELLE MASON
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Credential | LCSW
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Telephone | 804-733-1180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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