Provider Demographics
NPI:1215788328
Name:LANCE, TATYANA GEVON (LMSW)
Entity type:Individual
Prefix:MRS
First Name:TATYANA
Middle Name:GEVON
Last Name:LANCE
Suffix:
Gender:F
Credentials:LMSW
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 1:2411 N OAK ST STE 301L
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-3165
Practice Address - Country:US
Practice Address - Phone:843-687-5438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16731104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker