Provider Demographics
NPI:1790379287
Name:TUBBS, TAVIA CHENELLE (LCSWA)
Entity Type:Individual
Prefix:
First Name:TAVIA
Middle Name:CHENELLE
Last Name:TUBBS
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12209 JESSICA PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-1465
Mailing Address - Country:US
Mailing Address - Phone:704-516-4413
Mailing Address - Fax:
Practice Address - Street 1:1909 J N PEASE PL STE 201
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4546
Practice Address - Country:US
Practice Address - Phone:980-242-7090
Practice Address - Fax:980-556-7219
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0156321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical