Provider Demographics
NPI:1841745783
Name:HOUSTON, TANESHA
Entity Type:Individual
Prefix:
First Name:TANESHA
Middle Name:
Last Name:HOUSTON
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 1:11219 HERON PL
Mailing Address - Street 2:A
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4816
Mailing Address - Country:US
Mailing Address - Phone:301-752-5264
Mailing Address - Fax:
Practice Address - Street 1:2255 CRAIN HWY
Practice Address - Street 2:107
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-3164
Practice Address - Country:US
Practice Address - Phone:301-752-5264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-21
Last Update Date:2016-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist