Provider Demographics
NPI:1336752195
Name:SANCKO, SUWANNE TAQUISE (LPC)
Entity Type:Individual
Prefix:
First Name:SUWANNE
Middle Name:TAQUISE
Last Name:SANCKO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 WOODLANDS DR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-2482
Mailing Address - Country:US
Mailing Address - Phone:347-798-7378
Mailing Address - Fax:
Practice Address - Street 1:1215 HIGHTOWER TRL STE D102
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30350-6207
Practice Address - Country:US
Practice Address - Phone:678-444-4505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC012989101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional