Provider Demographics
NPI:1861007064
Name:STALLINGS, TARA TANKSLEY (MA PC , CCL)
Entity type:Individual
Prefix:MS
First Name:TARA
Middle Name:TANKSLEY
Last Name:STALLINGS
Suffix:
Gender:F
Credentials:MA PC , CCL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 JEANINE WAY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-2169
Mailing Address - Country:US
Mailing Address - Phone:706-294-9924
Mailing Address - Fax:
Practice Address - Street 1:1734 JENKINS ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-3736
Practice Address - Country:US
Practice Address - Phone:706-294-9924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No174H00000XOther Service ProvidersHealth Educator