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General NPI Number Information
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NPI Number | 1255620332
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Entity Type | Individual
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Provider Name | KEISHA T TANNER LPC
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Gender | Female
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Dates
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Enumeration Date | 03/29/2011
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 289 JONESBORO RD STE 150
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City | MCDONOUGH
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State | GA
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Zip | 30253-3725
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Country | US
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Telephone | 470-894-7932
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Fax |
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Provider Business Mailing Address
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Address Line | 289 JONESBORO RD STE 150
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City | MCDONOUGH
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State | GA
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Zip | 30253-3725
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Country | US
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Telephone | 470-894-7932
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | APC002881
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC007711
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License Number State | GA
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