Provider Demographics
NPI:1598313389
Name:ROSE-PARKER, TYSHAUNA (CSAC)
Entity Type:Individual
Prefix:
First Name:TYSHAUNA
Middle Name:
Last Name:ROSE-PARKER
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 PURDY RD
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:VA
Mailing Address - Zip Code:23847-2752
Mailing Address - Country:US
Mailing Address - Phone:434-637-0549
Mailing Address - Fax:
Practice Address - Street 1:2217 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-7046
Practice Address - Country:US
Practice Address - Phone:804-213-0249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701012653101YP2500X
VA0710103264101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional