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General NPI Number Information
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NPI Number | 1790483154
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Entity Type | Individual
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Provider Name | TATIANA RITA REYES
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Gender | Female
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Dates
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Enumeration Date | 02/15/2023
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Last Update Date | 02/15/2023
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Provider Practice Location Address
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Address Line | 9900 OLD KEENE MILL RD
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City | BURKE
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State | VA
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Zip | 22015-3903
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Country | US
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Telephone | 703-250-2450
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Fax |
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Provider Business Mailing Address
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Address Line | 8632 BRISTLECONE PL
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City | SPRINGFIELD
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State | VA
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Zip | 22153-1524
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Country | US
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Telephone | 571-344-1879
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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 | 0704013229
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License Number State | VA
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