Provider Demographics
NPI:1063805950
Name:TINES, TAMECA WALKER (LPC)
Entity type:Individual
Prefix:
First Name:TAMECA
Middle Name:WALKER
Last Name:TINES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5635 SHEALS LN
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-1976
Mailing Address - Country:US
Mailing Address - Phone:301-404-7474
Mailing Address - Fax:
Practice Address - Street 1:8620 ROLLING RD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-3828
Practice Address - Country:US
Practice Address - Phone:703-257-4661
Practice Address - Fax:703-257-4771
Is Sole Proprietor?:No
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006081101YP2500X
MDLC2027101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional