Provider Demographics
NPI:1841624335
Name:STOKES, TARA WEATHERS (MA)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:WEATHERS
Last Name:STOKES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 CROSSBOW DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-1627
Mailing Address - Country:US
Mailing Address - Phone:803-476-3800
Mailing Address - Fax:
Practice Address - Street 1:257 CROSSBOW DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-1627
Practice Address - Country:US
Practice Address - Phone:803-476-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC158056103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool