Provider Demographics
NPI:1851429088
Name:TANKERSLEY, LELIA ANNE (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:LELIA
Middle Name:ANNE
Last Name:TANKERSLEY
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2808 FALLSMONT DR
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-2247
Mailing Address - Country:US
Mailing Address - Phone:410-879-6432
Mailing Address - Fax:
Practice Address - Street 1:22 LINWOOD AVE
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3951
Practice Address - Country:US
Practice Address - Phone:410-877-3245
Practice Address - Fax:410-877-3245
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04667101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1069012 00Medicaid
MD42175504OtherBCBS SOCIAL WK PROVIDER
MD4474386OtherAETNA SOCIAL WORK PROVIDE
MHR4500001OtherBCBS FED SOCIAL WK PROVID
MD42175504OtherBCBS SOCIAL WK PROVIDER