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General NPI Number Information
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NPI Number | 1407050982
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Entity Type | Individual
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Provider Name | TAWANA TONEKE OLDS-DAVIS L.C.S.W
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Gender | Female
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 10/06/2022
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Provider Practice Location Address
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Address Line | 4305 HILLBROOK AVE
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City | RICHMOND
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State | VA
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Zip | 23231
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Country | US
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Telephone | 804-432-2153
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Fax |
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Provider Business Mailing Address
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Address Line | 4305 HILLBROOK AVE
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City | RICHMOND
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State | VA
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Zip | 23231-2140
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Country | US
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Telephone | 804-441-2145
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0904006149
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License Number State | VA
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