Basic Information
| Provider Information | |||||||||
| NPI: | 1285275826 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TATUM | ||||||||
| FirstName: | DANA | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | LPC, CCHP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4255 WADE GREEN RD NW STE 414 | ||||||||
| Address2: | |||||||||
| City: | KENNESAW | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301441763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6782132194 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1060 GAINES SCHOOL RD STE B3 | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306056323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6782132194 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2019 | ||||||||
| LastUpdateDate: | 10/04/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LPC003384 | GA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.