Provider Demographics
NPI:1093484180
Name:FOSTER-HOLLAND, TAWANA SELINA
Entity Type:Individual
Prefix:
First Name:TAWANA
Middle Name:SELINA
Last Name:FOSTER-HOLLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-5639
Mailing Address - Country:US
Mailing Address - Phone:757-535-7971
Mailing Address - Fax:
Practice Address - Street 1:646 3RD AVE
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-5639
Practice Address - Country:US
Practice Address - Phone:757-535-7971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health