Provider Demographics
NPI:1659674778
Name:TABB, SHIRLEY LINDA (LICSW)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:LINDA
Last Name:TABB
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 K ST NW
Mailing Address - Street 2:# 618
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-5500
Mailing Address - Country:US
Mailing Address - Phone:202-289-1923
Mailing Address - Fax:202-289-8556
Practice Address - Street 1:200 K ST NW
Practice Address - Street 2:# 618
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-5500
Practice Address - Country:US
Practice Address - Phone:202-289-1923
Practice Address - Fax:202-289-8556
Is Sole Proprietor?:No
Enumeration Date:2010-12-11
Last Update Date:2010-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCLC302794OtherDISTRICT OF COLUMBIA HEALTH PROFESSIONAL LICENSING ADMINISTRATION