Provider Demographics
NPI:1164040499
Name:KRNETA, TIJA
Entity Type:Individual
Prefix:
First Name:TIJA
Middle Name:
Last Name:KRNETA
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 1:20 STONERIDGE DR STE 202
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-6579
Mailing Address - Country:US
Mailing Address - Phone:540-941-8933
Mailing Address - Fax:
Practice Address - Street 1:20 STONERIDGE DR STE 202
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-6579
Practice Address - Country:US
Practice Address - Phone:540-941-8933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-13
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701009142101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health