Provider Demographics
NPI:1255987608
Name:PACK, TABITHA SALYER (LPC)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:SALYER
Last Name:PACK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TABITHA
Other - Middle Name:CORTNEY
Other - Last Name:SALYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3111 N LEE HWY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450-3200
Mailing Address - Country:US
Mailing Address - Phone:405-999-1297
Mailing Address - Fax:
Practice Address - Street 1:3111 N LEE HWY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-3200
Practice Address - Country:US
Practice Address - Phone:540-999-1297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12694101YP2500X
VA0701010582101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional