Provider Demographics
NPI:1679907059
Name:DEVLIN, TARA-MARIE
Entity Type:Individual
Prefix:
First Name:TARA-MARIE
Middle Name:
Last Name:DEVLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:M
Other - Last Name:TOSETTO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:PO BOX 604050
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-4050
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9101 PINEVILLE MATTHEWS RD STE C4
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28134-8840
Practice Address - Country:US
Practice Address - Phone:980-202-7920
Practice Address - Fax:980-301-9830
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC98371041C0700X
NCC0129051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical