Provider Demographics
NPI:1215505110
Name:DIRLA, TABETHA R (LPC-MHSP)
Entity type:Individual
Prefix:
First Name:TABETHA
Middle Name:R
Last Name:DIRLA
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 LOCKHART RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-1598
Mailing Address - Country:US
Mailing Address - Phone:404-430-3338
Mailing Address - Fax:
Practice Address - Street 1:1930 LOCKHART RIDGE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-1598
Practice Address - Country:US
Practice Address - Phone:404-430-3338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5641101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health