Provider Demographics
NPI:1790367878
Name:TABB GARCIA, CHRISTYL M (MS)
Entity Type:Individual
Prefix:
First Name:CHRISTYL
Middle Name:M
Last Name:TABB GARCIA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:AIMEE
Other - Middle Name:
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:344 KEPNER DR NE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-5145
Mailing Address - Country:US
Mailing Address - Phone:850-225-6949
Mailing Address - Fax:850-362-6826
Practice Address - Street 1:103 LEWIS ST
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-3142
Practice Address - Country:US
Practice Address - Phone:850-374-3333
Practice Address - Fax:850-362-6826
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19147101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health