Provider Demographics
NPI:1336470780
Name:TANTILLO, KAREN (LCSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:TANTILLO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 LAUREL SPRINGS PKWY
Mailing Address - Street 2:602
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6056
Mailing Address - Country:US
Mailing Address - Phone:678-213-2194
Mailing Address - Fax:678-213-2215
Practice Address - Street 1:5400 LAUREL SPRINGS PKWY
Practice Address - Street 2:602
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6056
Practice Address - Country:US
Practice Address - Phone:678-213-2194
Practice Address - Fax:678-213-2215
Is Sole Proprietor?:No
Enumeration Date:2010-01-25
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW004053104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker