Provider Demographics
NPI:1770216103
Name:MILLER, TABATHA SUE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TABATHA
Middle Name:SUE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TABATHA
Other - Middle Name:SUE
Other - Last Name:MANSFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 REMINGTON DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-8202
Mailing Address - Country:US
Mailing Address - Phone:501-410-1567
Mailing Address - Fax:
Practice Address - Street 1:9701 W MARKHAM ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2123
Practice Address - Country:US
Practice Address - Phone:717-449-0458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-04
Last Update Date:2022-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7815-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical