Provider Demographics
NPI:1447833900
Name:SINGLETON, TESSAH GRACE
Entity type:Individual
Prefix:
First Name:TESSAH
Middle Name:GRACE
Last Name:SINGLETON
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 1:1525 MERRILL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-1665
Mailing Address - Country:US
Mailing Address - Phone:870-826-8525
Mailing Address - Fax:
Practice Address - Street 1:1525 MERRILL DR STE 100
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-1665
Practice Address - Country:US
Practice Address - Phone:870-826-8525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician