Provider Demographics
NPI:1184922296
Name:PANKEY, TABATHA LATOYA (MSW, PLCSW)
Entity type:Individual
Prefix:MRS
First Name:TABATHA
Middle Name:LATOYA
Last Name:PANKEY
Suffix:
Gender:F
Credentials:MSW, PLCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3617 CASTLEFIELD LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-9691
Mailing Address - Country:US
Mailing Address - Phone:910-551-1741
Mailing Address - Fax:
Practice Address - Street 1:3617 CASTLEFIELD LN
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-9691
Practice Address - Country:US
Practice Address - Phone:910-551-1741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0058461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical