Provider Demographics
NPI:1023559382
Name:MORRALL, TANIA (LMT)
Entity Type:Individual
Prefix:MS
First Name:TANIA
Middle Name:
Last Name:MORRALL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8116 RONDA DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-8928
Mailing Address - Country:US
Mailing Address - Phone:843-321-7733
Mailing Address - Fax:843-779-4052
Practice Address - Street 1:8116 RONDA DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-8928
Practice Address - Country:US
Practice Address - Phone:843-321-7733
Practice Address - Fax:843-779-4052
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-19
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10319405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional