Provider Demographics
NPI:1164781233
Name:DANTZLER, KARLNEQUA MARIEONNE (BS CHILD AND FAMIL)
Entity type:Individual
Prefix:MRS
First Name:KARLNEQUA
Middle Name:MARIEONNE
Last Name:DANTZLER
Suffix:
Gender:F
Credentials:BS CHILD AND FAMIL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1867 CRANE RIDGE DR STE 150C
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4982
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13131 MS 603
Practice Address - Street 2:SUITE #102
Practice Address - City:KILN
Practice Address - State:MS
Practice Address - Zip Code:39556
Practice Address - Country:US
Practice Address - Phone:228-466-4690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-10
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00018214Medicaid