Provider Demographics
NPI:1790901254
Name:TOLBERT, YVETTE ROXANNE (LPCC-S, ATR-BC, NCC)
Entity Type:Individual
Prefix:DR
First Name:YVETTE
Middle Name:ROXANNE
Last Name:TOLBERT
Suffix:
Gender:F
Credentials:LPCC-S, ATR-BC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 728
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:SC
Mailing Address - Zip Code:29703-0728
Mailing Address - Country:US
Mailing Address - Phone:216-702-2455
Mailing Address - Fax:
Practice Address - Street 1:1823 APPLE TREE LN
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-9791
Practice Address - Country:US
Practice Address - Phone:803-802-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6615101YP2500X
OHE 0600311101YP2500X
OHE.0600311-SUPV101YP2500X
221700000X
SC6821101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist