Provider Demographics
NPI:1932829785
Name:INNOCENT, TEKSHIA
Entity Type:Individual
Prefix:
First Name:TEKSHIA
Middle Name:
Last Name:INNOCENT
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 1:966 HUNGERFORD DR STE 20A
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-1741
Mailing Address - Country:US
Mailing Address - Phone:240-681-5058
Mailing Address - Fax:
Practice Address - Street 1:966 HUNGERFORD DR STE 20A
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-1741
Practice Address - Country:US
Practice Address - Phone:240-681-5058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28298104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker