Provider Demographics
NPI:1568902765
Name:MANN, TABITHA (LCSW)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:MANN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12191 CARDAMOM DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-1448
Mailing Address - Country:US
Mailing Address - Phone:703-491-1913
Mailing Address - Fax:
Practice Address - Street 1:12191 CARDAMOM DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-1448
Practice Address - Country:US
Practice Address - Phone:703-491-1913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040056151041C0700X
DCLC500802221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical