MEDICARE: MS. TAWANA HERRING LICSW

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	1041C0700X	Clinical Social Worker	LC3000730	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	278016	OTHER	DC	AMERIGROUP

General Provider Information

NPI Number	:	1790998433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TAWANA HERRING LICSW

Provider Business Mailing Address
First Line	:	820 S COLUMBUS ST
Second Line	:	B25
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-4289
Country	:	US
Telephone Number	:	301-300-6549
Fax Number	:

Provider Business Practice Location Address
First Line	:	820 S COLUMBUS ST
Second Line	:	B25
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-4289
Country	:	US
Telephone Number	:	301-300-6549
Fax Number	:

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

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	06/02/2010

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