Healthcare Provider Details

I. General information

NPI: 1982010328
Provider Name (Legal Business Name): TARA R PRATER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 08/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

583C E RIVERSIDE DR
NORTH TAZEWELL VA
24630-9573
US

IV. Provider business mailing address

PO BOX 729
SALTVILLE VA
24370-0729
US

V. Phone/Fax

Practice location:
  • Phone: 276-979-9899
  • Fax: 276-979-9798
Mailing address:
  • Phone: 276-496-4492
  • Fax: 276-496-4839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904008645
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: