Provider Demographics
NPI:1497499149
Name:KLEEHAMMER, TABITHA KATHLEEN
Entity Type:Individual
Prefix:MRS
First Name:TABITHA
Middle Name:KATHLEEN
Last Name:KLEEHAMMER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TABITHA
Other - Middle Name:KLEEHAMMER
Other - Last Name:MACDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8280 WILLOW OAKS CORPORATE DR STE 600
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4516
Mailing Address - Country:US
Mailing Address - Phone:888-922-2843
Mailing Address - Fax:855-568-2494
Practice Address - Street 1:8280 WILLOW OAKS CORPORATE DR STE 600
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4516
Practice Address - Country:US
Practice Address - Phone:888-922-2843
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician