Provider Demographics
NPI:1215718853
Name:VICKERS, TANEIL JADE
Entity type:Individual
Prefix:
First Name:TANEIL
Middle Name:JADE
Last Name:VICKERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 SAINT ANTHONY AVE APT 115
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-4103
Mailing Address - Country:US
Mailing Address - Phone:504-229-1491
Mailing Address - Fax:
Practice Address - Street 1:4300 S I-10 SERVICE RD W MATAIRIE
Practice Address - Street 2:SUITE 117
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70002
Practice Address - Country:US
Practice Address - Phone:504-841-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor