Provider Demographics
NPI:1225846850
Name:TAMBORNINI, TINA FAIRCHILD (LCSW)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:FAIRCHILD
Last Name:TAMBORNINI
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 1:114 GRAYTON WAY
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-4847
Mailing Address - Country:US
Mailing Address - Phone:707-321-2421
Mailing Address - Fax:
Practice Address - Street 1:114 GRAYTON WAY
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-4847
Practice Address - Country:US
Practice Address - Phone:707-321-2421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-30
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty