Provider Demographics
NPI:1750871794
Name:EVERETT E. TOLBERT
Entity type:Organization
Organization Name:EVERETT E. TOLBERT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:EVERETT
Authorized Official - Middle Name:E
Authorized Official - Last Name:TOLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:912-220-7564
Mailing Address - Street 1:33 BRANDLE WAY
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-2764
Mailing Address - Country:US
Mailing Address - Phone:912-220-7564
Mailing Address - Fax:912-335-5655
Practice Address - Street 1:5302 FREDERICK ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4812
Practice Address - Country:US
Practice Address - Phone:912-220-7564
Practice Address - Fax:912-335-5655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008212251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health