Provider Demographics
NPI:1770318107
Name:SMITH, TABITHA (MSW)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 MAGNOLIA CT APT A
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:31763-2300
Mailing Address - Country:US
Mailing Address - Phone:229-376-1327
Mailing Address - Fax:
Practice Address - Street 1:165 CEDRIC ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:GA
Practice Address - Zip Code:31763-5027
Practice Address - Country:US
Practice Address - Phone:229-405-1900
Practice Address - Fax:229-304-4486
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0524480471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical