Individual
MRS. TISHA L GHOLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14201 MASADA CT, CHESTERFIELD, VA 23838-8725
(804) 299-0058
Mailing address
14201 MASADA CT, CHESTERFIELD, VA 23838-8725
(804) 299-0058
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
175T00000X
Peer Specialist
Primary
0735001482
VA
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
Other
Enumeration date
05/26/2020
Last updated
04/14/2026
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