Provider Demographics
NPI:1982365987
Name:GREWAL, TARNDIP KAUR
Entity Type:Individual
Prefix:
First Name:TARNDIP
Middle Name:KAUR
Last Name:GREWAL
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 1:19970 ST. LOUIS ROAD
Mailing Address - Street 2:
Mailing Address - City:PURCEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132
Mailing Address - Country:US
Mailing Address - Phone:703-576-5700
Mailing Address - Fax:
Practice Address - Street 1:19970 ST. LOUIS ROAD
Practice Address - Street 2:
Practice Address - City:PURCEVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132
Practice Address - Country:US
Practice Address - Phone:703-576-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician