Provider Demographics
NPI:1689165110
Name:ACOSTA, TANYA (MS)
Entity Type:Individual
Prefix:MS
First Name:TANYA
Middle Name:
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6715 GRAND MARINA CIR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30506-7811
Mailing Address - Country:US
Mailing Address - Phone:678-865-7072
Mailing Address - Fax:
Practice Address - Street 1:1 HUNTINGTON RD STE 801
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-7216
Practice Address - Country:US
Practice Address - Phone:706-552-0450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional