Provider Demographics
NPI:1295368256
Name:CARBO, TAMMERA
Entity Type:Individual
Prefix:
First Name:TAMMERA
Middle Name:
Last Name:CARBO
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 1:150 DU RHU DR APT 102
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1221
Mailing Address - Country:US
Mailing Address - Phone:251-455-5867
Mailing Address - Fax:
Practice Address - Street 1:150 DU RHU DR APT 102
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1221
Practice Address - Country:US
Practice Address - Phone:251-455-5867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1940101YP2500X
FLMH3198101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health