Healthcare Provider Details

I. General information

NPI: 1306198528
Provider Name (Legal Business Name): TENEKA NADIA GERIDO LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 TOWNE PARK DR STE 200
RINCON GA
31326-5324
US

IV. Provider business mailing address

595 TOWNE PARK DR STE 200
RINCON GA
31326-5324
US

V. Phone/Fax

Practice location:
  • Phone: 912-785-2100
  • Fax:
Mailing address:
  • Phone: 912-785-2100
  • Fax: 912-368-3868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC008583
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: