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General NPI Number Information
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NPI Number | 1578039681
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Entity Type | Organization
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Legal Business Name | T.A.G. INC.
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Dates
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Enumeration Date | 10/16/2018
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Last Update Date | 10/16/2018
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Provider Practice Location Address
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Address Line | 4305 SARELLEN RD STE C
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City | RICHMOND
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State | VA
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Zip | 23231-4311
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Country | US
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Telephone | 804-303-3309
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Fax |
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Provider Business Mailing Address
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Address Line | 4305 SARELLEN RD STE C
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City | RICHMOND
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State | VA
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Zip | 23231-4311
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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 | CEO
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Name | MR. JAQUAN WINSTON
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Credential |
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Telephone | 804-303-3309
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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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