Provider Demographics
NPI:1396370359
Name:VANVRANKEN, TABITHA ANN (LMSW)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:ANN
Last Name:VANVRANKEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 SINGLETREE CIR
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-8651
Mailing Address - Country:US
Mailing Address - Phone:865-332-6120
Mailing Address - Fax:
Practice Address - Street 1:512 SINGLETREE CIR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-8651
Practice Address - Country:US
Practice Address - Phone:865-332-6120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW0000010462104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker