Provider Demographics
NPI:1801413406
Name:BLOUNT, TAMARA LAVETTE
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:LAVETTE
Last Name:BLOUNT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 E VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-8194
Mailing Address - Country:US
Mailing Address - Phone:704-218-2914
Mailing Address - Fax:
Practice Address - Street 1:351 E VILLAGE DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-8194
Practice Address - Country:US
Practice Address - Phone:704-218-2914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0154371041C0700X
NCP0146821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical