Provider Demographics
NPI:1790397230
Name:TAG COUNSELING LLC
Entity Type:Organization
Organization Name:TAG COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:THARKUR
Authorized Official - Suffix:
Authorized Official - Credentials:MA LMHC MCAP ICADC
Authorized Official - Phone:904-547-0480
Mailing Address - Street 1:233 W SILVERTHORN LN
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-7001
Mailing Address - Country:US
Mailing Address - Phone:305-803-6029
Mailing Address - Fax:
Practice Address - Street 1:2233 PARK AVE STE 302
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5569
Practice Address - Country:US
Practice Address - Phone:305-803-6029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-17
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty