Provider Demographics
NPI:1235301086
Name:TABB, DARLETTA L
Entity Type:Individual
Prefix:MRS
First Name:DARLETTA
Middle Name:L
Last Name:TABB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12451 NORMA LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63138-1461
Mailing Address - Country:US
Mailing Address - Phone:314-335-0253
Mailing Address - Fax:314-741-0139
Practice Address - Street 1:12451 NORMA LN
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63138-1461
Practice Address - Country:US
Practice Address - Phone:314-335-0253
Practice Address - Fax:314-741-0139
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health