Provider Demographics
NPI:1194540039
Name:TISLER, DEBRA (MSED, QMHPC-T,)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:TISLER
Suffix:
Gender:F
Credentials:MSED, QMHPC-T,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5765F BURKE CENTRE PKWY # 112
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-2233
Mailing Address - Country:US
Mailing Address - Phone:571-302-6287
Mailing Address - Fax:
Practice Address - Street 1:11711 LAKEWOOD LN
Practice Address - Street 2:
Practice Address - City:FAIRFAX STATION
Practice Address - State:VA
Practice Address - Zip Code:22039-2102
Practice Address - Country:US
Practice Address - Phone:571-302-6287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-16
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator