Provider Demographics
NPI:1285024802
Name:CALLAHAN, TANESHA (LPC)
Entity Type:Individual
Prefix:
First Name:TANESHA
Middle Name:
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 LYNN KATIE CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-9022
Mailing Address - Country:US
Mailing Address - Phone:678-650-9050
Mailing Address - Fax:770-217-4587
Practice Address - Street 1:310 LYNN KATIE CT
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-9022
Practice Address - Country:US
Practice Address - Phone:678-650-9050
Practice Address - Fax:770-217-4587
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC 008068101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional