Provider Demographics
NPI:1659741346
Name:POLIDOR YARBER, TANIA
Entity Type:Individual
Prefix:MRS
First Name:TANIA
Middle Name:
Last Name:POLIDOR YARBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GEPERNARD
Other - Middle Name:TANIA
Other - Last Name:POLIDOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 746724
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6724
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:312-929-0373
Practice Address - Street 1:1007 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-7007
Practice Address - Country:US
Practice Address - Phone:336-200-7010
Practice Address - Fax:704-710-8592
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0099911041C0700X
NCC0111771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical