Provider Demographics
NPI:1508369976
Name:HOKE-MUJIHAD, TABITHA L (LSW)
Entity Type:Individual
Prefix:MS
First Name:TABITHA
Middle Name:L
Last Name:HOKE-MUJIHAD
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:643 SACKMAN ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-1096
Mailing Address - Country:US
Mailing Address - Phone:419-631-0903
Mailing Address - Fax:
Practice Address - Street 1:780 PARK AVE W STE D
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-3009
Practice Address - Country:US
Practice Address - Phone:419-709-8103
Practice Address - Fax:419-709-8132
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH17003591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical