Healthcare Provider Details

I. General information

NPI: 1538072269
Provider Name (Legal Business Name): TABATHA ANN NICOLE CONN MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2986 ROBERT C BYRD DR
BECKLEY WV
25801-4448
US

IV. Provider business mailing address

143 DANIELS TER
DANIELS WV
25832-9750
US

V. Phone/Fax

Practice location:
  • Phone: 304-963-6887
  • Fax:
Mailing address:
  • Phone: 304-731-9685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberAP00947145
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: