Provider Demographics
NPI:1497212450
Name:MANLEY, TAMARA MAE (LICSW)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:MAE
Last Name:MANLEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:MAE
Other - Last Name:SAVAII
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2839 HYLAND ST
Mailing Address - Street 2:
Mailing Address - City:DUPONT
Mailing Address - State:WA
Mailing Address - Zip Code:98327-8728
Mailing Address - Country:US
Mailing Address - Phone:801-830-3096
Mailing Address - Fax:
Practice Address - Street 1:9040 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-1000
Practice Address - Country:US
Practice Address - Phone:253-968-1390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA613400401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical