Provider Demographics
NPI:1215788328
Name:LANCE, TATYANA GEVON (MSW, LMSW,LCSWA)
Entity type:Individual
Prefix:MRS
First Name:TATYANA
Middle Name:GEVON
Last Name:LANCE
Suffix:
Gender:F
Credentials:MSW, LMSW,LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 N OAK ST STE 301L
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-3165
Mailing Address - Country:US
Mailing Address - Phone:843-687-5438
Mailing Address - Fax:
Practice Address - Street 1:1905 J N PEASE PL STE 103
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4509
Practice Address - Country:US
Practice Address - Phone:704-910-0136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-27
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0229001041C0700X
SC16731104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical