MEDICARE: ATHENA LUCIA TATUM LCSW, MSW, MPA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C014474	NC
2	1041C0700X	Clinical Social Worker	SW17650	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972771285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ATHENA LUCIA TATUM LCSW, MSW, MPA

Provider Business Mailing Address
First Line	:	1633 NEW GARDEN RD UNIT 388
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-2001
Country	:	US
Telephone Number	:	858-503-4590
Fax Number	:

Provider Business Practice Location Address
First Line	:	1633 NEW GARDEN RD UNIT 388
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-2001
Country	:	US
Telephone Number	:	850-345-9007
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2008
Last Update Date	:	03/23/2026

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