TISA MCKENNA (NPI# 1497185805) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497185805 |
| Entity Type | Individual |
| Full Name | TISA MCKENNA |
| Credential | LCSW |
| Practice Address |
11204 Waples Mill Rd Fairfax VA 22030 |
| Mailing Address |
11204 Waples Mill Rd Fairfax VA 22030-6036 |
| Practice Telephone | 7032188500 |
| Mailing Telephone | 7032188500 |
| Enumeration Date | 2013-11-21 |
| Last Update Date | 2019-10-30 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1041C0700X |
Social Worker Specialization: Clinical |
0904009000 | VA | Behavioral Health & Social Service Providers |
| N | 1041C0700X |
Social Worker Specialization: Clinical |
LC50079120 | DC | Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 14540 John Marshall Hwy, Gainesville, VA 201551691 | 7037980442 | |
| 621 W Main St, Purcellville, VA 201323012 | 5714771557 |
| Street Address |
11204 WAPLES MILL RD |
| City | FAIRFAX |
| State | VA |
| Zip Code | 22030 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770684367 | John Thomas Giroux | Psychologist | 11204 Waples Mill Rd, Fairfax, VA 22030-6048 | 2006-09-26 |
| 1265909097 | Jung Soo Lim | Counselor | 11204 Waples Mill Rd, Fairfax, VA 22030-6036 | 2018-10-30 |
| 1952819492 | Alissa Wulff | Counselor | 11204 Waples Mill Rd, Fairfax, VA 22030-6036 | 2018-01-18 |
| 1457880684 | Clinton Lee Brogdon | Counselor | 11204 Waples Mill Rd, Fairfax, VA 22030-6036 | 2017-06-10 |
| 1245685783 | Michelle Hendrickson | Psychologist | 11204 Waples Mill Rd, Fairfax, VA 22030-6036 | 2016-05-03 |
| 1295126118 | Molly A Jakubek | Marriage & Family Therapist | 11204 Waples Mill Rd, Fairfax, VA 22030-6036 | 2015-02-13 |
| 1598161119 | Alexandra T Heard | Social Worker | 11204 Waples Mill Rd, Fairfax, VA 22030-6036 | 2014-11-10 |
| 1841635653 | Kristen Messenger | Counselor | 11204 Waples Mill Rd, Fairfax, VA 22030-6036 | 2013-05-07 |
| 1285970087 | Catherine A Rathman | Psychologist | 11204 Waples Mill Rd, Fairfax, VA 22030-6036 | 2012-12-26 |
| 1083959373 | Ravinderpal Singh | Psychiatry & Neurology | 11204 Waples Mill Rd, Fairfax, VA 22030-6036 | 2012-11-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205449477 | Perry Camp Jr. | Psychologist | 4403 Dixie Hill Rd, Unit 205, Fairfax, VA 22030 | 2020-08-28 |
| 1952940322 | Brightview Fair Oaks, LLC | Alzheimer Center (Dementia Center) | 12725 Lee Highway, Fairfax, VA 22030 | 2020-01-02 |
| 1245871524 | Tori Sprowl | Behavioral Analyst | 10430 Democracy Lane #102b & 103, Fairfax, VA 22030 | 2019-10-08 |
| 1528612124 | Paul Sarigianis | Student in an Organized Health Care Education/Training Program | 10379b Democracy Lane, Fairfax, VA 22030 | 2019-07-31 |
| 1497221303 | Kahak, Inc. | Day Training, Developmentally Disabled Services | 10560 Main Street Suite Ps100, Fairfax, VA 22030 | 2018-10-17 |
| 1689177073 | Shamoona Sharif | Dentist | 11050 Lee Hwy, Fairfax, VA 22030 | 2018-03-13 |
| 1205339538 | Rachael Lee Greene | Social Worker | 4403 Dixie Hill Rd. #206, Fairfax, VA 22030 | 2018-03-13 |
| 1558863027 | Jacqueline Renee Bauer | Skilled Nursing Facility | 10701 Main Street, Fairfax, VA 22030 | 2018-03-01 |
| 1275033607 | Philajo Global LLC | Non-emergency Medical Transport (VAN) | 4521 Billingham Street, Fairfax, VA 22030 | 2018-02-12 |
| 1376050401 | Alexander Harrison | Counselor | 4400 University Drive, Ms 2a2, Fairfax, VA 22030 | 2018-01-10 |
| Find all providers in zip 22030 | ||||
| Taxonomy Code | 1041C0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Social Worker |
| Specialization | Clinical |
| A social worker who holds a master’s or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master’s supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. |
| Notes: Source: National Association of Social Workers, 2008 [7/1/2009: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285234021 | Sabrina Kafin Weiskind | Social Worker | 13221 Point Pleasant Dr, Fairfax, VA 22033-3508 | 2020-10-30 |
| 1154920163 | Vera D Daniel | Social Worker | 4110 Chain Bridge Rd Ste 316, Fairfax, VA 22030-4020 | 2020-10-21 |
| 1154931632 | Brooke Varma | Social Worker | 2971 Lismore Ln, Fairfax, VA 22031-2138 | 2020-08-09 |
| 1922629179 | Emily Tilman | Social Worker | 3524 Country Hill Dr, Fairfax, VA 22030-1818 | 2020-04-29 |
| 1790318236 | Joyce L Montgomery | Social Worker | 10615 Judicial Dr Ste 103, Fairfax, VA 22030-7501 | 2020-02-12 |
| 1356972368 | Minoo Pakdaman | Social Worker | 4290 Birney Ln, Fairfax, VA 22033-4333 | 2020-01-29 |
| 1790323467 | Dorine Ndayizigiye | Social Worker | 10615 Judicial Dr Ste 301, Fairfax, VA 22030-7501 | 2019-12-12 |
| 1245897776 | Susan Morris Robertory | Social Worker | 9117 Kristin Ln, Fairfax, VA 22032-1424 | 2019-05-21 |
| 1083183032 | Brooke Diane Postlewaite | Social Worker | 4110 Chain Bridge Rd Ste 214, Fairfax, VA 22030-4020 | 2018-11-20 |
| 1871061499 | Michelle Brown | Social Worker | 8221 Willow Oaks Corporate Dr # L-306g, Fairfax, VA 22031-4512 | 2018-11-13 |
| Find all providers in FAIRFAX | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.