Provider Demographics
NPI:1932479599
Name:TANYA S. ROBERTSON LCSW LLC
Entity Type:Organization
Organization Name:TANYA S. ROBERTSON LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:804-218-6316
Mailing Address - Street 1:5516 FALMOUTH ST
Mailing Address - Street 2:VISTAS II, SUITE 102
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-1819
Mailing Address - Country:US
Mailing Address - Phone:804-218-6316
Mailing Address - Fax:804-282-0012
Practice Address - Street 1:5516 FALMOUTH ST
Practice Address - Street 2:VISTAS II, SUITE 102
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1819
Practice Address - Country:US
Practice Address - Phone:804-218-6316
Practice Address - Fax:804-282-0012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904006220261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health