Provider Demographics
NPI:1669281994
Name:SEARS, TEQUILA (LCSW)
Entity type:Individual
Prefix:
First Name:TEQUILA
Middle Name:
Last Name:SEARS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3984 LAKE MANOR WAY
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-8226
Mailing Address - Country:US
Mailing Address - Phone:954-294-4870
Mailing Address - Fax:
Practice Address - Street 1:3984 LAKE MANOR WAY
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-8226
Practice Address - Country:US
Practice Address - Phone:954-294-4870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1041S0200X
GACSW0093861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool