Provider Demographics
NPI:1649747296
Name:SCOTLAND, TIANNA
Entity Type:Individual
Prefix:
First Name:TIANNA
Middle Name:
Last Name:SCOTLAND
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 1:1275 BRENTWOOD RD NE APT 2
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-1035
Mailing Address - Country:US
Mailing Address - Phone:202-999-7617
Mailing Address - Fax:
Practice Address - Street 1:1100 H ST NW STE 640
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-5476
Practice Address - Country:US
Practice Address - Phone:202-846-8043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS-345-793-622-917103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst