Provider Demographics
NPI:1912776683
Name:STRACHAN, TEDJILA V (CCM, ABA, TC)
Entity Type:Individual
Prefix:PROF
First Name:TEDJILA
Middle Name:V
Last Name:STRACHAN
Suffix:
Gender:F
Credentials:CCM, ABA, TC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 PELHAM PKWY S APT 708
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1145
Mailing Address - Country:US
Mailing Address - Phone:347-861-8672
Mailing Address - Fax:
Practice Address - Street 1:1680 PELHAM PKWY S APT 708
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1145
Practice Address - Country:US
Practice Address - Phone:347-861-8672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YP1600X
101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty