# CORNITA MENTAL HEALTH SERVICES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Cordelia Nieketien-Tawari
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134524580
- **Authorized official:** CORDELIA NIEKETIEN-TAWARI DNP, APRN-BC, LNP (CEO/PSYCH NP PROBIDER)
- **Authorized official phone:** (703) 869-5361

## Contact information

- **Practice address:** 1800 TOWN CENTER DR STE 420, RESTON, VA 20190-3240
- **Practice address phone:** (703) 869-5361
- **Practice address fax:** (703) 957-3625
- **Mailing address:** PO BOX 2692, RESTON, VA 20195-0692
- **Mailing address phone:** (703) 869-5361
- **Mailing address fax:** (703) 957-3625

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163W00000X | Registered Nurse | 0017137987 | VA | — |
| 363LF0000X | Family Nurse Practitioner | 0024165883 | VA | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 0024165883 | VA | Yes |

## Other

- **Enumeration date:** 10/28/2014
- **Last updated:** 03/25/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0024165883 | VA STATE BOARD OF NURSING-NP LICENSE | VA |
| 01 | — | 1134524580 | NPI (2) | VA |
| 01 | — | 11946976 | CAQH NO. | VA |
| 01 | — | 1194827139 | NPI (1) | VA |