Provider Demographics
NPI:1013487396
Name:WASHINGTON, TANIKIA (MA)
Entity type:Individual
Prefix:
First Name:TANIKIA
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 HERITAGE WAY NE STE 102
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-4544
Mailing Address - Country:US
Mailing Address - Phone:571-233-9712
Mailing Address - Fax:
Practice Address - Street 1:2313 RED TIDE RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-1203
Practice Address - Country:US
Practice Address - Phone:910-703-2848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-29
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA374J00000X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional