Provider Demographics
NPI:1649744699
Name:HERRERA ANAYA, TANIA GUADALUPE
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:GUADALUPE
Last Name:HERRERA ANAYA
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 1:44927 GEORGE WASHINGTON BLVD STE 265
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-4294
Mailing Address - Country:US
Mailing Address - Phone:571-799-0660
Mailing Address - Fax:
Practice Address - Street 1:44927 GEORGE WASHINGTON BLVD STE 265
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-4294
Practice Address - Country:US
Practice Address - Phone:571-799-0660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-13
Last Update Date:2019-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician