Provider Demographics
NPI:1245981588
Name:YEANAY, MIATTA ROBERTS
Entity type:Individual
Prefix:
First Name:MIATTA
Middle Name:ROBERTS
Last Name:YEANAY
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 1:712 FRANCIS RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-4523
Mailing Address - Country:US
Mailing Address - Phone:804-665-5230
Mailing Address - Fax:
Practice Address - Street 1:712 FRANCIS RD
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-4523
Practice Address - Country:US
Practice Address - Phone:804-665-5230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704014058101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor