Provider Demographics
NPI:1073242947
Name:VENABLE, TARA
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:VENABLE
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 1:789 PINEY FOREST RD STE 1
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-2877
Mailing Address - Country:US
Mailing Address - Phone:434-208-2987
Mailing Address - Fax:434-729-9740
Practice Address - Street 1:789 PINEY FOREST RD STE 1
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-2877
Practice Address - Country:US
Practice Address - Phone:434-208-2987
Practice Address - Fax:434-729-9740
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker