Provider Demographics
NPI:1306273388
Name:PENDLETON, TIKEISHA DANIELLE (LMSW)
Entity type:Individual
Prefix:
First Name:TIKEISHA
Middle Name:DANIELLE
Last Name:PENDLETON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1283 MURFREESBORO PIKE STE 500
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-2421
Mailing Address - Country:US
Mailing Address - Phone:800-592-2974
Mailing Address - Fax:
Practice Address - Street 1:1270 W SILVERLAKE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-2728
Practice Address - Country:US
Practice Address - Phone:520-351-8104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-04
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-13818104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker