Provider Demographics
NPI:1881911097
Name:TOMBERLIN, MICHAELA J (MA)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:J
Last Name:TOMBERLIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4123 OLD PORTMAN RD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29626-5346
Mailing Address - Country:US
Mailing Address - Phone:864-353-3384
Mailing Address - Fax:864-222-9715
Practice Address - Street 1:125 MUDDY TOES DR
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29626-5349
Practice Address - Country:US
Practice Address - Phone:864-353-3384
Practice Address - Fax:864-222-9715
Is Sole Proprietor?:No
Enumeration Date:2010-04-27
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5163101YP2500X
NC3453101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional