Provider Demographics
NPI:1578370482
Name:BUCHANAN, TANEEKA RENEE
Entity type:Individual
Prefix:
First Name:TANEEKA
Middle Name:RENEE
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14884 EMBERDALE DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-2678
Mailing Address - Country:US
Mailing Address - Phone:703-986-9774
Mailing Address - Fax:
Practice Address - Street 1:7600 LEESBURGE PIKE WEST BLDG SUITE 204
Practice Address - Street 2:WEST BUILDING SUITE 204
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22043
Practice Address - Country:US
Practice Address - Phone:703-553-3131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1220216103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst