Healthcare Provider Details

I. General information

NPI: 1205747136
Provider Name (Legal Business Name): TATUM CHILD AND FAMILY COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 MUIRS CHAPEL RD STE 302
GREENSBORO NC
27410-6176
US

IV. Provider business mailing address

204 MUIRS CHAPEL RD STE 302
GREENSBORO NC
27410-6176
US

V. Phone/Fax

Practice location:
  • Phone: 336-270-9118
  • Fax:
Mailing address:
  • Phone: 336-270-9118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: ATHENA TATUM
Title or Position: OWNER
Credential: LCSW
Phone: 850-345-9007