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General NPI Number Information
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NPI Number | 1346551546
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Entity Type | Individual
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Provider Name | TANIEKA ANNALIECIA GENTLES LMHC
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Gender | Female
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Dates
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Enumeration Date | 06/23/2010
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Last Update Date | 01/17/2017
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Provider Practice Location Address
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Address Line | 38 FRONT ST 5TH FLOOR
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City | WORCESTER
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State | MA
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Zip | 01608-1732
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Country | US
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Telephone | 508-756-2005
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Fax |
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Provider Business Mailing Address
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Address Line | 10 NUTTALL LN APT 7
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City | WORCESTER
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State | MA
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Zip | 01604-4848
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Country | US
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Telephone | 774-242-0312
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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 | 9499
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License Number State | MA
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