MEDICARE: MRS. TAWANDA MCPHATTER LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0701005118	VA

General Provider Information

NPI Number	:	1013444876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAWANDA MCPHATTER LPC

Provider Business Mailing Address
First Line	:	2200 BOULEVARD STE C
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2305
Country	:	US
Telephone Number	:	804-319-7990
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 BOULEVARD STE C
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2305
Country	:	US
Telephone Number	:	804-319-7990
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	11/28/2022

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