Provider Demographics
NPI:1225536832
Name:TARRANCE, PATRICK EUGENE JR (LMSW)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:EUGENE
Last Name:TARRANCE
Suffix:JR
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 FOREST HILL RD APT 205
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-4840
Mailing Address - Country:US
Mailing Address - Phone:313-715-1437
Mailing Address - Fax:
Practice Address - Street 1:1826 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-3620
Practice Address - Country:US
Practice Address - Phone:478-272-1210
Practice Address - Fax:478-274-5585
Is Sole Proprietor?:No
Enumeration Date:2018-01-29
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW007792104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker