Provider Demographics
NPI:1831664721
Name:TOMPKINS, TAMARA DAWN (CDCA, QMHS)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:DAWN
Last Name:TOMPKINS
Suffix:
Gender:F
Credentials:CDCA, QMHS
Other - Prefix:MS
Other - First Name:TAMARA
Other - Middle Name:DAWN
Other - Last Name:KONKLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4635 SCHILLING DR
Mailing Address - Street 2:
Mailing Address - City:STOCKPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43787
Mailing Address - Country:US
Mailing Address - Phone:740-974-5463
Mailing Address - Fax:
Practice Address - Street 1:113 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW LEXINGTON
Practice Address - State:OH
Practice Address - Zip Code:43764
Practice Address - Country:US
Practice Address - Phone:740-343-6135
Practice Address - Fax:740-342-2914
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-08
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
OHCDCA.182928101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0320366Medicaid