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General NPI Number Information
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NPI Number | 1568960268
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Entity Type | Individual
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Provider Name | TANESHA DANIELLE WALKER LPC
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Gender | Female
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Dates
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Enumeration Date | 01/28/2018
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Last Update Date | 12/01/2020
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Provider Practice Location Address
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Address Line | 55 ATLANTA ST SE
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City | MARIETTA
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State | GA
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Zip | 30060-1977
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Country | US
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Telephone | 470-238-9475
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Fax | 470-533-1545
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Provider Business Mailing Address
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Address Line | PO BOX 158
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City | MARIETTA
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State | GA
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Zip | 30061-0158
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Country | US
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Telephone | 773-263-6533
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Fax | 470-533-1545
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC009713
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License Number State | GA
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