Provider Demographics
NPI:1396167912
Name:TABB, CHRISTOPHER WEST III (LGPC)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:WEST
Last Name:TABB
Suffix:III
Gender:M
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11841 MAN O WAR LN
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-3361
Mailing Address - Country:US
Mailing Address - Phone:410-808-2291
Mailing Address - Fax:443-664-6670
Practice Address - Street 1:11841 MAN O WAR LN
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-3361
Practice Address - Country:US
Practice Address - Phone:410-808-2291
Practice Address - Fax:443-664-6670
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-16
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP5500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional