Provider Demographics
NPI:1417139015
Name:ROBERTSON, TANYA S (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:S
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:TANYA
Other - Middle Name:L
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2800 N PARHAM RD STE 210
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4409
Mailing Address - Country:US
Mailing Address - Phone:804-218-6316
Mailing Address - Fax:804-282-0012
Practice Address - Street 1:2800 N PARHAM RD STE 210
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4409
Practice Address - Country:US
Practice Address - Phone:804-218-6316
Practice Address - Fax:804-282-0012
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2020-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040062201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical