Provider Demographics
NPI:1154999241
Name:NGUYEN, TATIANA HENANI (RBT)
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:HENANI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 MARLIN DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-6315
Mailing Address - Country:US
Mailing Address - Phone:757-377-8005
Mailing Address - Fax:
Practice Address - Street 1:11835 FISHING POINT DR STE 202
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2585
Practice Address - Country:US
Practice Address - Phone:757-243-1033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician