Individual
TABITHA WERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
2403 MAIN DR STE 1&2, FAYETTEVILLE, AR 72704-5223
(479) 249-6379
Mailing address
PO DRAWER 2109, RUSSELLVILLE, AR 72811
(479) 967-2322
(479) 967-2876
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
292402795
—
AR
Enumeration date
11/15/2022
Last updated
01/11/2023
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