Provider Demographics
NPI:1366148363
Name:MAIZEL, TATYANA (MA,LPC, NCC, CCTP)
Entity type:Individual
Prefix:
First Name:TATYANA
Middle Name:
Last Name:MAIZEL
Suffix:
Gender:F
Credentials:MA,LPC, NCC, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 GARRISONVILLE RD STE 116
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-8900
Mailing Address - Country:US
Mailing Address - Phone:540-782-8878
Mailing Address - Fax:
Practice Address - Street 1:385 GARRISONVILLE RD.
Practice Address - Street 2:SUITE 116
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554
Practice Address - Country:US
Practice Address - Phone:540-782-8878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701014396101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional