Individual
TYREE DEANA TALLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CSAC-S, QMHP A/C
Contact information
Practice address
4860 COX RD # 244, GLEN ALLEN, VA 23060-9275
(804) 503-8454
Mailing address
122 N CEDAR AVE, HENRICO, VA 23075-1429
(804) 503-8454
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
0732008364
VA
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0709024432
VA
Other
Enumeration date
05/31/2023
Last updated
05/31/2023
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