Provider Information for 1619506367
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TARA BREWSTER LINEBERRY LCSW
Sex: Female
NPI: 1619506367
Last Updated: 2023-07-16
Certification Date: 2023-07-16
Certification Date: 2023-07-16
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1619506367 | ||||||||||||
| Enumeration Date | 2020-04-05 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 180 W MAIN ST STE 6 WYTHEVILLE, VA 24382-2304 United States Phone: 276-200-4521 | Fax: | ||||||||||||
| Primary Practice Address | 180 W MAIN ST STE 6 WYTHEVILLE, VA 24382-2304 United States Phone: 276-200-4521 | Fax: | ||||||||||||
| Secondary Practice Address(es) | 3450 W LEE HWY | ||||||||||||
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