Provider Demographics
NPI:1588426886
Name:EISA, TAREK (QPPMH, RBT)
Entity type:Individual
Prefix:
First Name:TAREK
Middle Name:
Last Name:EISA
Suffix:
Gender:M
Credentials:QPPMH, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 INDEPENDENCE BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-5461
Mailing Address - Country:US
Mailing Address - Phone:757-785-3338
Mailing Address - Fax:855-847-6797
Practice Address - Street 1:293 INDEPENDENCE BLVD STE 400
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-5461
Practice Address - Country:US
Practice Address - Phone:757-785-3338
Practice Address - Fax:855-847-6797
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician