Provider Demographics
NPI:1154840486
Name:TANCK, DAVEISHA MERCEDES (LCSWA)
Entity type:Individual
Prefix:MRS
First Name:DAVEISHA
Middle Name:MERCEDES
Last Name:TANCK
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7943 ROLLING MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-3349
Mailing Address - Country:US
Mailing Address - Phone:561-317-2777
Mailing Address - Fax:
Practice Address - Street 1:919 N MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2355
Practice Address - Country:US
Practice Address - Phone:561-317-2777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-19
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0128801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical