Provider Demographics
NPI:1396594206
Name:IRVING, TAWANNA TAVEINE
Entity type:Individual
Prefix:
First Name:TAWANNA
Middle Name:TAVEINE
Last Name:IRVING
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 1:3015 CARRIAGE LN
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-4105
Mailing Address - Country:US
Mailing Address - Phone:404-740-6399
Mailing Address - Fax:
Practice Address - Street 1:3015 CARRIAGE LN
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-4105
Practice Address - Country:US
Practice Address - Phone:404-740-6399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician