Provider Demographics
NPI:1558802892
Name:TYLER, MARQUIA RENEE (LCSW)
Entity Type:Individual
Prefix:
First Name:MARQUIA
Middle Name:RENEE
Last Name:TYLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8513 OAKVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23228-2818
Mailing Address - Country:US
Mailing Address - Phone:804-264-1659
Mailing Address - Fax:888-868-5899
Practice Address - Street 1:8513 OAKVIEW AVE
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23228-2818
Practice Address - Country:US
Practice Address - Phone:804-264-1659
Practice Address - Fax:888-868-5899
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040088261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0904008826OtherSTATE LICENSE