Provider Demographics
NPI:1942667688
Name:TINSLEY, DEJERICA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DEJERICA
Middle Name:
Last Name:TINSLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DEJERICA
Other - Middle Name:
Other - Last Name:HEATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:540 POWDER SPRINGS ST STE 17
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-3549
Mailing Address - Country:US
Mailing Address - Phone:404-590-5524
Mailing Address - Fax:229-252-7584
Practice Address - Street 1:540 POWDER SPRINGS ST STE 17
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-3549
Practice Address - Country:US
Practice Address - Phone:404-590-5524
Practice Address - Fax:229-252-7584
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-26
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0093941041C0700X
GACSW0061631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty