Provider Demographics
NPI:1578144291
Name:KNOLL, TAMMY DENISE (LCSW)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:DENISE
Last Name:KNOLL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:DENISE
Other - Last Name:MONTGOMERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12992 ABNER AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5602
Mailing Address - Country:US
Mailing Address - Phone:757-633-7535
Mailing Address - Fax:
Practice Address - Street 1:12992 ABNER AVE
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-5602
Practice Address - Country:US
Practice Address - Phone:757-633-7535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2023-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040128081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical