Provider Demographics
NPI:1619218120
Name:SAPP, TANISHA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:TANISHA
Middle Name:
Last Name:SAPP
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 1:289 JONESBORO RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-3725
Mailing Address - Country:US
Mailing Address - Phone:770-809-3709
Mailing Address - Fax:
Practice Address - Street 1:1700 PENNSYLVANIA AVE
Practice Address - Street 2:STE 207
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-9115
Practice Address - Country:US
Practice Address - Phone:770-809-3709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2016-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007896101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional