Provider Demographics
NPI:1548952153
Name:ZIMMERMAN, TOMITHA ELLEN (LCSWA)
Entity type:Individual
Prefix:
First Name:TOMITHA
Middle Name:ELLEN
Last Name:ZIMMERMAN
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 1:350 PEE DEE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-4945
Mailing Address - Country:US
Mailing Address - Phone:740-404-7068
Mailing Address - Fax:
Practice Address - Street 1:350 PEE DEE AVE STE 101
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-4945
Practice Address - Country:US
Practice Address - Phone:740-404-7068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0186711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical