Provider Demographics
NPI:1477273365
Name:HARRELL, TAMA (LMSW)
Entity Type:Individual
Prefix:
First Name:TAMA
Middle Name:
Last Name:HARRELL
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 1:1707 SEAWEED CT
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29575-4632
Mailing Address - Country:US
Mailing Address - Phone:843-267-2581
Mailing Address - Fax:843-652-1219
Practice Address - Street 1:4181 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5019
Practice Address - Country:US
Practice Address - Phone:843-652-6607
Practice Address - Fax:843-652-1219
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5603104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker