Provider Demographics
NPI:1780298042
Name:O'BRIANT, TABITHA LAUREN (MSW, LCSWA)
Entity type:Individual
Prefix:MISS
First Name:TABITHA
Middle Name:LAUREN
Last Name:O'BRIANT
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:MRS
Other - First Name:TABITHA
Other - Middle Name:O'BRIANT
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW,LCSWA
Mailing Address - Street 1:1501 DOCK ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-4936
Mailing Address - Country:US
Mailing Address - Phone:910-254-9898
Mailing Address - Fax:
Practice Address - Street 1:1501 DOCK ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-4936
Practice Address - Country:US
Practice Address - Phone:910-254-9898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0149891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical