Provider Demographics
NPI:1235902883
Name:TUTT, TANESHA GOLDWIRE (DHED, LMSW, CHES)
Entity Type:Individual
Prefix:
First Name:TANESHA
Middle Name:GOLDWIRE
Last Name:TUTT
Suffix:
Gender:F
Credentials:DHED, LMSW, CHES
Other - Prefix:
Other - First Name:TANESHA
Other - Middle Name:S
Other - Last Name:GOLDWIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 42
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30091-0042
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3823 ROD PL
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-3367
Practice Address - Country:US
Practice Address - Phone:678-860-5953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20541174H00000X
GAMSW009698104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No174H00000XOther Service ProvidersHealth Educator