Provider Demographics
NPI:1619783008
Name:WALTON, TABITHA R (LCSW)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:R
Last Name:WALTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8994 HIGHWAY 70
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-5809
Mailing Address - Country:US
Mailing Address - Phone:360-450-1064
Mailing Address - Fax:
Practice Address - Street 1:8994 HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-5809
Practice Address - Country:US
Practice Address - Phone:615-422-5161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1224471041C0700X
TN93321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA122447OtherSTATE OF CALIFORNIA BOARD OF BEHAVIORAL SCIENCES
TN9332OtherTENNESSEE BOARD OF SOCIAL WORKER LICENSURE