Organization
CORNITA MENTAL HEALTH SERVICES, LLC
Active
Other names
Cordelia Nieketien-Tawari
Organization subpart
No
Provider details
NPI number
Authorized official
CORDELIA NIEKETIEN-TAWARI DNP, APRN-BC, LNP (CEO/PSYCH NP PROBIDER)
(703) 869-5361
Entity
Organization
Contact information
Practice address
1800 TOWN CENTER DR STE 420, RESTON, VA 20190-3240
(703) 869-5361
(703) 957-3625
Mailing address
PO BOX 2692, RESTON, VA 20195-0692
(703) 869-5361
(703) 957-3625
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0017137987
VA
363LF0000X
Family Nurse Practitioner
0024165883
VA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
0024165883
VA
Other
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
Enumeration date
10/28/2014
Last updated
03/25/2024
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