Provider Demographics
NPI:1538497052
Name:MILES, TABITHA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TABITHA
Middle Name:
Last Name:MILES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:TABITHA
Other - Middle Name:
Other - Last Name:GARRIOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 31569
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37930-1569
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:162 MARKET PLACE BLVD
Practice Address - Street 2:STE D
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-2337
Practice Address - Country:US
Practice Address - Phone:865-212-6600
Practice Address - Fax:865-313-2149
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-20
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical