Provider Demographics
NPI:1093279978
Name:TNM MENTAL HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:TNM MENTAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:MALLOY
Authorized Official - Suffix:
Authorized Official - Credentials:QMHP-A, QMHP-C, MED
Authorized Official - Phone:757-613-7349
Mailing Address - Street 1:4010 FORT HUGER DR
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23430-5418
Mailing Address - Country:US
Mailing Address - Phone:757-613-7349
Mailing Address - Fax:
Practice Address - Street 1:4010 FORT HUGER DR
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:VA
Practice Address - Zip Code:23430-5418
Practice Address - Country:US
Practice Address - Phone:757-613-7349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)