Provider Demographics
NPI:1396086021
Name:RAINEY, TABATHA NICOLE (LCSWA)
Entity type:Individual
Prefix:MS
First Name:TABATHA
Middle Name:NICOLE
Last Name:RAINEY
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 1:3007 MATTHEWS DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-1222
Mailing Address - Country:US
Mailing Address - Phone:704-915-9285
Mailing Address - Fax:
Practice Address - Street 1:110 S STERLING ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3483
Practice Address - Country:US
Practice Address - Phone:828-433-4567
Practice Address - Fax:828-433-4576
Is Sole Proprietor?:No
Enumeration Date:2013-03-05
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP007689Medicaid