Provider Demographics
NPI:1316089691
Name:KABALA, TANIE MILLER (PHD)
Entity type:Individual
Prefix:DR
First Name:TANIE
Middle Name:MILLER
Last Name:KABALA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 WASHINGTON LN
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-6832
Mailing Address - Country:US
Mailing Address - Phone:610-793-0472
Mailing Address - Fax:302-234-1017
Practice Address - Street 1:5301 LIMESTONE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-1250
Practice Address - Country:US
Practice Address - Phone:302-234-3443
Practice Address - Fax:302-234-1017
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0000698103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical