Provider Demographics
NPI:1508654740
Name:TOOMER, TENNILLE (EED)
Entity type:Individual
Prefix:DR
First Name:TENNILLE
Middle Name:
Last Name:TOOMER
Suffix:
Gender:
Credentials:EED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 MAYFLOWER RD APT 6F
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23508-2755
Mailing Address - Country:US
Mailing Address - Phone:757-639-0096
Mailing Address - Fax:
Practice Address - Street 1:4601 MAYFLOWER RD APT 6F
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23508-2755
Practice Address - Country:US
Practice Address - Phone:757-639-0096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty