Provider Demographics
NPI:1538250949
Name:TANKERSLEY, THOMAS J (LPC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:TANKERSLEY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6128 BUCKLAND MILL RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-6736
Mailing Address - Country:US
Mailing Address - Phone:540-265-2973
Mailing Address - Fax:
Practice Address - Street 1:3025 PETERS CREEK RD NW STE A
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-2760
Practice Address - Country:US
Practice Address - Phone:540-352-7611
Practice Address - Fax:540-362-0973
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002886101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health