Provider Demographics
NPI:1285713750
Name:TJERSLAND, TIMOTHY POWELL (PSYD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:POWELL
Last Name:TJERSLAND
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 GREENBRIER PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2876
Mailing Address - Country:US
Mailing Address - Phone:757-436-2444
Mailing Address - Fax:757-547-4584
Practice Address - Street 1:1403 GREENBRIER PKWY STE 200
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2876
Practice Address - Country:US
Practice Address - Phone:757-436-2444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003598103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010251010Medicaid