Provider Demographics
NPI:1891464806
Name:COLVIN, TABITHA ANGEL
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:ANGEL
Last Name:COLVIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CLIPBOARD AGENCY
Mailing Address - Street 2:340 SOUTH LEMON AVE
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789
Mailing Address - Country:US
Mailing Address - Phone:408-837-0116
Mailing Address - Fax:424-402-5049
Practice Address - Street 1:119 MEADOW GLEN PKWY
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-4237
Practice Address - Country:US
Practice Address - Phone:408-837-0116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor