Provider Demographics
NPI:1457683666
Name:TABOR, MAKARIOS (MSW, LISW-CP, CAC I)
Entity Type:Individual
Prefix:
First Name:MAKARIOS
Middle Name:
Last Name:TABOR
Suffix:
Gender:M
Credentials:MSW, LISW-CP, CAC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:691 S OAK ST
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-3827
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:691 S OAK ST
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678
Practice Address - Country:US
Practice Address - Phone:864-882-7563
Practice Address - Fax:864-882-7388
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17051511101YA0400X
SC115101041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical