Provider Demographics
NPI:1104515469
Name:NANCE, TELONIA SHANNON (MPH)
Entity type:Individual
Prefix:
First Name:TELONIA
Middle Name:SHANNON
Last Name:NANCE
Suffix:
Gender:F
Credentials:MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3022 DANFIELD DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-3159
Mailing Address - Country:US
Mailing Address - Phone:843-617-7212
Mailing Address - Fax:
Practice Address - Street 1:1140 BRIARGATE CIR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-6504
Practice Address - Country:US
Practice Address - Phone:803-764-3011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
SC307682101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool