Provider Demographics
NPI:1346551546
Name:GENTLES, TANIEKA ANNALIECIA (LMHC)
Entity Type:Individual
Prefix:PROF
First Name:TANIEKA
Middle Name:ANNALIECIA
Last Name:GENTLES
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 NUTTALL LN APT 7
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-4848
Mailing Address - Country:US
Mailing Address - Phone:774-242-0312
Mailing Address - Fax:
Practice Address - Street 1:38 FRONT ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1732
Practice Address - Country:US
Practice Address - Phone:508-756-2005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9499101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health