Provider Demographics
NPI:1780187518
Name:MCCOY, TANEKA MARIE (CRC, LCMHC, LCAS-A,)
Entity Type:Individual
Prefix:MS
First Name:TANEKA
Middle Name:MARIE
Last Name:MCCOY
Suffix:
Gender:F
Credentials:CRC, LCMHC, LCAS-A,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6329 UNITY ST STE D
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-7186
Mailing Address - Country:US
Mailing Address - Phone:336-255-4394
Mailing Address - Fax:
Practice Address - Street 1:6329 UNITY ST STE D
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-7186
Practice Address - Country:US
Practice Address - Phone:336-255-4394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-18
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401018441101Y00000X
NCLCAS-24448101YA0400X
13822101YM0800X
NC13822101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional