Provider Demographics
NPI:1063119733
Name:TYNES MENTAL HEALTH AGENCY LLC
Entity type:Organization
Organization Name:TYNES MENTAL HEALTH AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAKESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-718-6361
Mailing Address - Street 1:5215 COLLEY AVE STE 136
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23508-2172
Mailing Address - Country:US
Mailing Address - Phone:757-321-0463
Mailing Address - Fax:757-395-4531
Practice Address - Street 1:5215 COLLEY AVE STE 138
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23508-2172
Practice Address - Country:US
Practice Address - Phone:757-321-0463
Practice Address - Fax:757-257-0082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-13
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health