Healthcare Provider Details

I. General information

NPI: 1912242785
Provider Name (Legal Business Name): TASHA J TEMPLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2012
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 17TH ST NW UNIT 4032
ATLANTA GA
30363-2010
US

IV. Provider business mailing address

390 17TH ST NW UNIT 4032
ATLANTA GA
30363-2010
US

V. Phone/Fax

Practice location:
  • Phone: 678-744-5514
  • Fax:
Mailing address:
  • Phone: 678-744-5514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number16988
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC009004
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number16988
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLPC009004
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC009004
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number16988
License Number StateNC
# 7
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC009004
License Number StateGA
# 8
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number16988
License Number StateNC
# 9
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD004513
License Number StateGA
# 10
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberLD004513
License Number StateGA
# 11
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License NumberLD004513
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: