Provider Demographics
NPI:1912639501
Name:MARTIN, TABITHA LYNETTE
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:LYNETTE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 ALPINE CT
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-4818
Mailing Address - Country:US
Mailing Address - Phone:410-419-5518
Mailing Address - Fax:
Practice Address - Street 1:8 ALPINE CT
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4818
Practice Address - Country:US
Practice Address - Phone:410-419-5518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician