=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538072269
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TABATHA ANN NICOLE CONN MSW, LSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2026
-----------------------------------------------------
Last Update Date | 09/24/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2986 ROBERT C BYRD DR
-----------------------------------------------------
City | BECKLEY
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25801-4448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-963-6887
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 143 DANIELS TER
-----------------------------------------------------
City | DANIELS
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25832-9750
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-731-9685
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | AP00947145
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------