Tionell Waddler, LPC | |
24195 Belleau Ave, Quantico, VA 22134-5106 | |
(703) 719-1054 | |
Not Available |
Full Name | Tionell Waddler |
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Gender | Female |
Speciality | Counselor - Mental Health |
Location | 24195 Belleau Ave, Quantico, Virginia |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1912267261 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YM0800X | Counselor - Mental Health | 0701008108 (Virginia) | Primary |
Entity Name | Grow Healthcare Group Pa |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1245845932 PECOS PAC ID: 3476961368 Enrollment ID: O20221213001514 |
Mailing Address | Practice Location Address |
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Tionell Waddler, LPC 17 Ridge Rd, Stafford, VA 22556-1242 Ph: (571) 230-7182 | Tionell Waddler, LPC 24195 Belleau Ave, Quantico, VA 22134-5106 Ph: (703) 719-1054 |
Joyce Phillips, Counselor Medicare: Not Enrolled in Medicare Practice Location: 12026 Mason Dr, Quantico, VA 22134 Phone: 703-842-7984 | |
Sarah Elizabeth Ellen, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 411 Broadway St, Quantico, VA 22134 Phone: 240-921-8566 Fax: 240-623-9818 | |
Mr. Ras Benzo, C.P.T/C.F.L. Counselor Medicare: Not Enrolled in Medicare Practice Location: 13517 Upham St, Quantico, VA 22134 Phone: 571-330-2384 |