Provider Demographics
NPI:1437887197
Name:SMALL, TANEQUA DANIELLE (LMSW)
Entity Type:Individual
Prefix:
First Name:TANEQUA
Middle Name:DANIELLE
Last Name:SMALL
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 1:7788 LAKE CROSS DR E
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-2835
Mailing Address - Country:US
Mailing Address - Phone:901-205-6141
Mailing Address - Fax:
Practice Address - Street 1:103 S AVALON ST
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-4165
Practice Address - Country:US
Practice Address - Phone:870-702-7657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker