Provider Demographics
NPI:1609675164
Name:SNOW, TARA JEAN (DDIV, CDAC)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:JEAN
Last Name:SNOW
Suffix:
Gender:
Credentials:DDIV, CDAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2748 LYNDHURST AVENUE
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103
Mailing Address - Country:US
Mailing Address - Phone:336-814-1429
Mailing Address - Fax:
Practice Address - Street 1:1840 EASTCHESTER DRIVE
Practice Address - Street 2:SUITE 106
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265
Practice Address - Country:US
Practice Address - Phone:336-278-1918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29108101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)