Healthcare Provider Details

I. General information

NPI: 1851210215
Provider Name (Legal Business Name): TENILLE REENA GAINES PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4665 DOBIE RD STE 335
OKEMOS MI
48864-2200
US

IV. Provider business mailing address

718 RIVER GARDENS DR
ATLANTA GA
30354-4402
US

V. Phone/Fax

Practice location:
  • Phone: 517-939-9534
  • Fax:
Mailing address:
  • Phone: 336-918-9918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY004852
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: