Provider Demographics
NPI:1225742869
Name:MURRAY, TANISHA (PHD STUDENT, MSW)
Entity Type:Individual
Prefix:MS
First Name:TANISHA
Middle Name:
Last Name:MURRAY
Suffix:
Gender:F
Credentials:PHD STUDENT, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5101 OLD MAIN ST APT 309
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23231-3011
Mailing Address - Country:US
Mailing Address - Phone:804-302-7434
Mailing Address - Fax:208-823-1520
Practice Address - Street 1:5101 OLD MAIN ST APT 309
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23231-3011
Practice Address - Country:US
Practice Address - Phone:804-302-7434
Practice Address - Fax:208-823-1520
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09060107981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1881308344OtherBEHAVIORAL HEALTH