Provider Demographics
NPI:1295363919
Name:HANNON, TANESHIA ROCHELLE (ALC)
Entity Type:Individual
Prefix:
First Name:TANESHIA
Middle Name:ROCHELLE
Last Name:HANNON
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 CHISHOLM RD STE 14
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-1346
Mailing Address - Country:US
Mailing Address - Phone:256-330-2060
Mailing Address - Fax:
Practice Address - Street 1:2222 CHISHOLM RD STE 14
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1346
Practice Address - Country:US
Practice Address - Phone:256-330-2060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-29
Last Update Date:2020-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional