Provider Demographics
NPI:1306463153
Name:HALL, TABITHA YOUNG (PHD, LMHC, NCC)
Entity type:Individual
Prefix:DR
First Name:TABITHA
Middle Name:YOUNG
Last Name:HALL
Suffix:
Gender:F
Credentials:PHD, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 PLYMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-3218
Mailing Address - Country:US
Mailing Address - Phone:850-218-3988
Mailing Address - Fax:
Practice Address - Street 1:313 PLYMOUTH AVE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-3218
Practice Address - Country:US
Practice Address - Phone:850-218-3988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-28
Last Update Date:2020-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10247101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor