Provider Demographics
NPI:1467107581
Name:GUINTY, TARA LEIGH
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:LEIGH
Last Name:GUINTY
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 1:4404 DELCO RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-2838
Mailing Address - Country:US
Mailing Address - Phone:804-319-5814
Mailing Address - Fax:
Practice Address - Street 1:596 MINUTEMAN DR
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-7000
Practice Address - Country:US
Practice Address - Phone:804-319-5814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-22-20392106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician