Healthcare Provider Details

I. General information

NPI: 1780298042
Provider Name (Legal Business Name): TABITHA LAUREN O'BRIANT MSW, LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TABITHA O'BRIANT COX MSW,LCSWA

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 DOCK ST
WILMINGTON NC
28401-4936
US

IV. Provider business mailing address

1501 DOCK ST
WILMINGTON NC
28401-4936
US

V. Phone/Fax

Practice location:
  • Phone: 910-254-9898
  • Fax:
Mailing address:
  • Phone: 910-254-9898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP014989
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: