1568960268 NPI number — TANESHA DANIELLE WALKER LPC

Table of content: (NPI 1447588140)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568960268 NPI number — TANESHA DANIELLE WALKER LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALKER
Provider First Name:
TANESHA
Provider Middle Name:
DANIELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568960268
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 158
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30061-0158
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-263-6533
Provider Business Mailing Address Fax Number:
470-533-1545

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 ATLANTA ST SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30060-1977
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
470-238-9475
Provider Business Practice Location Address Fax Number:
470-533-1545
Provider Enumeration Date:
01/28/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LPC009713 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: LPC009713 . This is a "STATE BOARD OF COUNSELORS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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