Individual
TANITA MARTIN-THAMES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2637 RIDGEWOOD RD STE G, JACKSON, MS 39216-4971
(913) 915-6236
Mailing address
PO BOX 2358, CLINTON, MS 39060-2358
(913) 915-6236
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C7489
MS
Other
Enumeration date
03/05/2014
Last updated
12/05/2018
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