Healthcare Provider Details

I. General information

NPI: 1821360280
Provider Name (Legal Business Name): TARA NITA TOLBERT TOWNSEND LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TARA NITA TOLBERT

II. Dates (important events)

Enumeration Date: 02/01/2012
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BORDEAUX LN
SAVANNAH GA
31419-2865
US

IV. Provider business mailing address

109 BORDEAUX LN
SAVANNAH GA
31419-2865
US

V. Phone/Fax

Practice location:
  • Phone: 912-376-9952
  • Fax: 912-307-3942
Mailing address:
  • Phone: 912-484-9590
  • Fax: 912-307-3942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW004134
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierCSW004134
Identifier TypeOTHER
Identifier StateGA
Identifier IssuerSTATE LICENSE
# 2
Identifier115300300
Identifier TypeMEDICAID
Identifier StateFL
Identifier IssuerFlorida Medicaid Provider ID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: