Provider Demographics
NPI:1295440758
Name:TABOR-FEDELE, CINDY CARYOL (SUD COUNSELOR)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:CARYOL
Last Name:TABOR-FEDELE
Suffix:
Gender:F
Credentials:SUD COUNSELOR
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:C
Other - Last Name:FEDELE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:611 E BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93701-1502
Mailing Address - Country:US
Mailing Address - Phone:559-237-3420
Mailing Address - Fax:
Practice Address - Street 1:611 E BELMONT AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-1502
Practice Address - Country:US
Practice Address - Phone:559-237-3420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14647101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)