Provider Demographics
NPI:1568805463
Name:INABINET, TISHIRO PATRISS (MA)
Entity Type:Individual
Prefix:MR
First Name:TISHIRO
Middle Name:PATRISS
Last Name:INABINET
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 GIBSON FOREST DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-3466
Mailing Address - Country:US
Mailing Address - Phone:803-520-6440
Mailing Address - Fax:
Practice Address - Street 1:211 GIBSON FOREST DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-3466
Practice Address - Country:US
Practice Address - Phone:803-520-6440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health