Provider Demographics
NPI:1770967317
Name:TANNER, ALEXIA MICHELLE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ALEXIA
Middle Name:MICHELLE
Last Name:TANNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ALEXIA
Other - Middle Name:MICHELLE
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2707
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-0909
Mailing Address - Country:US
Mailing Address - Phone:229-388-0932
Mailing Address - Fax:229-388-0933
Practice Address - Street 1:911 MAIN ST S
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-4867
Practice Address - Country:US
Practice Address - Phone:229-396-4689
Practice Address - Fax:229-396-4605
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2020-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0052101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical