Provider Demographics
NPI:1972911014
Name:TUBMAN, TINISI (LCSWA)
Entity type:Individual
Prefix:MS
First Name:TINISI
Middle Name:
Last Name:TUBMAN
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2524 REID OAKS DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-3167
Mailing Address - Country:US
Mailing Address - Phone:973-698-6249
Mailing Address - Fax:
Practice Address - Street 1:2524 REID OAKS DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-3167
Practice Address - Country:US
Practice Address - Phone:973-698-6249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP008709101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health