Provider Demographics
NPI:1134661580
Name:TYLER, JOWANDA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JOWANDA
Middle Name:
Last Name:TYLER
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 1:2620 SHERBOURNE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23237-1141
Mailing Address - Country:US
Mailing Address - Phone:804-980-3445
Mailing Address - Fax:
Practice Address - Street 1:2025 E MAIN ST STE 208
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-7073
Practice Address - Country:US
Practice Address - Phone:804-447-0193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040095171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical