Provider Demographics
NPI:1114046844
Name:TRICKETT, TOBI KRISTIN (MS)
Entity Type:Individual
Prefix:
First Name:TOBI
Middle Name:KRISTIN
Last Name:TRICKETT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:TOBI
Other - Middle Name:
Other - Last Name:TRICKETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:PO BOX 662
Mailing Address - Street 2:
Mailing Address - City:SNEADS FERRY
Mailing Address - State:NC
Mailing Address - Zip Code:28460-0662
Mailing Address - Country:US
Mailing Address - Phone:407-988-4563
Mailing Address - Fax:
Practice Address - Street 1:1401 WEST RD
Practice Address - Street 2:BUILDING #1401
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28547-2539
Practice Address - Country:US
Practice Address - Phone:407-988-4563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9527101YM0800X
VA701005587101YP2500X
26977101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)