Provider Demographics
NPI:1669090437
Name:TANKSLEY, ALEXSUNDRIA
Entity type:Individual
Prefix:
First Name:ALEXSUNDRIA
Middle Name:
Last Name:TANKSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 MIDDLETON ST # B
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5358
Mailing Address - Country:US
Mailing Address - Phone:843-379-3444
Mailing Address - Fax:
Practice Address - Street 1:1105 MIDDLETON ST # B
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5358
Practice Address - Country:US
Practice Address - Phone:843-379-3444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician