Provider Demographics
NPI:1033649157
Name:GREEN, TANYATTA DEANNA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TANYATTA
Middle Name:DEANNA
Last Name:GREEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 DOCK LANDING RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-1834
Mailing Address - Country:US
Mailing Address - Phone:757-537-3720
Mailing Address - Fax:
Practice Address - Street 1:222 W 19TH ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-2218
Practice Address - Country:US
Practice Address - Phone:757-622-7017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical