Provider Demographics
NPI:1629630603
Name:TABLER, DONNA M (AAS, QMHS)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:TABLER
Suffix:
Gender:F
Credentials:AAS, QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 S RIVERSIDE DR NE
Mailing Address - Street 2:
Mailing Address - City:MCCONNELSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43756-9102
Mailing Address - Country:US
Mailing Address - Phone:740-962-6933
Mailing Address - Fax:740-962-6305
Practice Address - Street 1:915 S RIVERSIDE DR NE
Practice Address - Street 2:
Practice Address - City:MCCONNELSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43756-9102
Practice Address - Country:US
Practice Address - Phone:740-962-5204
Practice Address - Fax:740-962-3688
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OH179282101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator