Provider Demographics
NPI:1326771205
Name:TATUM-WATTS, MARYANNE ELIZABETH (LCMHCA, CRC)
Entity Type:Individual
Prefix:
First Name:MARYANNE
Middle Name:ELIZABETH
Last Name:TATUM-WATTS
Suffix:
Gender:F
Credentials:LCMHCA, CRC
Other - Prefix:
Other - First Name:MARYANNE
Other - Middle Name:ELIZABETH
Other - Last Name:TATUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 WARBLER DR
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-9712
Mailing Address - Country:US
Mailing Address - Phone:910-612-0486
Mailing Address - Fax:
Practice Address - Street 1:322 8TH AVE E
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-3713
Practice Address - Country:US
Practice Address - Phone:828-708-7088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17781101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health