Organization
TANIKKA MASON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TANIKKA LASHELLE MASON LCSW (CHIEF CLINICAL OFFICER)
(804) 733-1180
Entity
Organization
Contact information
Practice address
2002 WAKEFIELD AVE, PETERSBURG, VA 23805-2112
(804) 733-1180
(804) 733-1181
Mailing address
2002 WAKEFIELD AVE, PETERSBURG, VA 23805-2112
(804) 733-1180
(804) 733-1181
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
09/19/2016
Last updated
09/19/2016
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