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General NPI Number Information
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NPI Number | 1164033783
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Entity Type | Individual
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Provider Name | TANEQUA S DORSEY LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/17/2020
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Last Update Date | 08/17/2020
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Provider Practice Location Address
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Address Line | 40 MACON STREET SUITE D
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City | MCDONOUGH
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State | GA
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Zip | 30253
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Country | US
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Telephone | 678-831-7377
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Fax |
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Provider Business Mailing Address
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Address Line | 3605 TINSLEY WAY SW
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City | ATLANTA
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State | GA
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Zip | 30331-5465
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Country | US
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Telephone | 404-697-7360
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CSW006924
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License Number State | GA
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