Provider Demographics
NPI:1952731481
Name:MELINE, TANYA LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:LYNN
Last Name:MELINE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 STAFFORD AVE
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-7246
Mailing Address - Country:US
Mailing Address - Phone:540-658-6520
Mailing Address - Fax:540-658-6042
Practice Address - Street 1:20 PENDLETON RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22405-3041
Practice Address - Country:US
Practice Address - Phone:540-373-7366
Practice Address - Fax:540-371-3788
Is Sole Proprietor?:No
Enumeration Date:2013-11-19
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPPS-06037361041S0200X
VA09040067001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool