Provider Demographics
NPI:1689172603
Name:HARGROVE, TANEESHA TERRY (LCSW)
Entity Type:Individual
Prefix:
First Name:TANEESHA
Middle Name:TERRY
Last Name:HARGROVE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TANEESHA
Other - Middle Name:MERSHELL
Other - Last Name:TERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:861 BERRYMAN PL
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-8297
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:690 COURTENAY DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306-3421
Practice Address - Country:US
Practice Address - Phone:404-875-4551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW008188104100000X
GACSW0074981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker