Provider Demographics
NPI:1346673480
Name:DELEON, TANYA FRANCES (LCSWA)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:FRANCES
Last Name:DELEON
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 SERENE CT NE
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-7793
Mailing Address - Country:US
Mailing Address - Phone:845-235-4870
Mailing Address - Fax:910-392-9559
Practice Address - Street 1:2875 WORTH DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-6248
Practice Address - Country:US
Practice Address - Phone:845-235-4870
Practice Address - Fax:910-392-9559
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0079951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical