Provider Information for 1497185805
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TISA MCKENNA PINKERTON LCSW
Sex: Female
NPI: 1497185805
Last Updated: 2022-06-30
Certification Date: 2022-06-30
Certification Date: 2022-06-30
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1497185805 | ||||||||||||
| Enumeration Date | 2013-11-21 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 11204 WAPLES MILL RD FAIRFAX, VA 22030-6036 United States Phone: 703-218-8500 | Fax: | ||||||||||||
| Primary Practice Address | 11204 WAPLES MILL RD FAIRFAX, VA 22030 United States Phone: 703-218-8500 | Fax: | ||||||||||||
| Secondary Practice Address(es) | 44679 ENDICOTT DR STE 412 621 W MAIN ST 14540 JOHN MARSHALL HWY 14540 JOHN MARSHALL HWY | ||||||||||||
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