Provider Demographics
NPI:1487006078
Name:SEADE, TABITHA
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:SEADE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11934 BROWNESTONE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-7175
Mailing Address - Country:US
Mailing Address - Phone:615-587-9511
Mailing Address - Fax:
Practice Address - Street 1:8825 UNIVERSITY EAST DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-4169
Practice Address - Country:US
Practice Address - Phone:704-537-3650
Practice Address - Fax:866-909-5364
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-06
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0092321041C0700X
TNLSW0000008264104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker