Provider Demographics
NPI:1609164730
Name:FOREMAN, TANGELLA (LCSW)
Entity Type:Individual
Prefix:
First Name:TANGELLA
Middle Name:
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TANGELLA
Other - Middle Name:
Other - Last Name:MENSAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2809 FOREST HOME RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-5320
Mailing Address - Country:US
Mailing Address - Phone:866-972-1268
Mailing Address - Fax:
Practice Address - Street 1:4001 COMMERCIAL CENTER DR STE 2
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:AR
Practice Address - Zip Code:72364-9616
Practice Address - Country:US
Practice Address - Phone:870-732-7920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4946-C1041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR226890719Medicaid