Provider Demographics
NPI:1558673418
Name:TOLBERT, DAVID C (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:TOLBERT
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 4TH ST
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32266-4733
Mailing Address - Country:US
Mailing Address - Phone:904-465-4503
Mailing Address - Fax:904-853-6285
Practice Address - Street 1:324 6TH AVE N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-5726
Practice Address - Country:US
Practice Address - Phone:904-465-4503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8992101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health