Provider Demographics
NPI:1073855490
Name:TAH SAMA, MAVIS N (HHA, PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:MAVIS
Middle Name:N
Last Name:TAH SAMA
Suffix:
Gender:F
Credentials:HHA, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 N PARHAM RD STE 120
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4422
Mailing Address - Country:US
Mailing Address - Phone:804-288-1881
Mailing Address - Fax:
Practice Address - Street 1:2810 N PARHAM RD STE 120
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4422
Practice Address - Country:US
Practice Address - Phone:804-288-1881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-24
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024191310363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty