Provider Demographics
NPI:1285182246
Name:TANIKKA MASON
Entity Type:Organization
Organization Name:TANIKKA MASON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF CLINICAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANIKKA
Authorized Official - Middle Name:LASHELLE
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:804-733-1180
Mailing Address - Street 1:2002 WAKEFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-2112
Mailing Address - Country:US
Mailing Address - Phone:804-733-1180
Mailing Address - Fax:804-733-1181
Practice Address - Street 1:2002 WAKEFIELD AVE
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-2112
Practice Address - Country:US
Practice Address - Phone:804-733-1180
Practice Address - Fax:804-733-1181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health