Provider Demographics
NPI:1568960268
Name:WALKER, TANESHA DANIELLE (LPC)
Entity Type:Individual
Prefix:
First Name:TANESHA
Middle Name:DANIELLE
Last Name:WALKER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30061-0158
Mailing Address - Country:US
Mailing Address - Phone:773-263-6533
Mailing Address - Fax:470-533-1545
Practice Address - Street 1:55 ATLANTA ST SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1977
Practice Address - Country:US
Practice Address - Phone:470-238-9475
Practice Address - Fax:470-533-1545
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-28
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009713101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC009713OtherSTATE BOARD OF COUNSELORS