Provider Demographics
NPI:1558020511
Name:DANIELS, TABITHA V
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:V
Last Name:DANIELS
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 1:4389 W MAYSFIELD DR STE 100
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-9648
Mailing Address - Country:US
Mailing Address - Phone:706-496-2856
Mailing Address - Fax:762-333-2872
Practice Address - Street 1:4389 W MAYSFIELD DR STE 100
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-9648
Practice Address - Country:US
Practice Address - Phone:706-496-2856
Practice Address - Fax:762-333-2872
Is Sole Proprietor?:No
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional