Provider Demographics
NPI:1265858237
Name:WHITE, TARA (CBRS SERVICES)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:CBRS SERVICES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2748
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28145-2748
Mailing Address - Country:US
Mailing Address - Phone:704-798-2851
Mailing Address - Fax:704-633-5461
Practice Address - Street 1:417 17TH ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:NC
Practice Address - Zip Code:28159-1913
Practice Address - Country:US
Practice Address - Phone:704-798-2851
Practice Address - Fax:704-633-5461
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-13
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency