Provider Demographics
NPI:1134949332
Name:PICKETT, TAMIA LASHONE
Entity type:Individual
Prefix:MRS
First Name:TAMIA
Middle Name:LASHONE
Last Name:PICKETT
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 1:7350 NC HIGHWAY 42
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-7387
Mailing Address - Country:US
Mailing Address - Phone:252-775-9005
Mailing Address - Fax:
Practice Address - Street 1:7350 NC HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-7387
Practice Address - Country:US
Practice Address - Phone:252-775-9005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-12
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10182101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health