Provider Demographics
NPI:1083990063
Name:MCGEACHY, TABITHA (LCSW)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:MCGEACHY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 FAIRFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-6607
Mailing Address - Country:US
Mailing Address - Phone:910-550-3803
Mailing Address - Fax:910-550-3803
Practice Address - Street 1:1511 PEAR TREE LN
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-4077
Practice Address - Country:US
Practice Address - Phone:336-255-5311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-23
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0072981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical