MEDICARE: DAVID C TOLBERT MA, LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH8992	FL

General Provider Information

NPI Number	:	1558673418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID C TOLBERT MA, LMHC

Provider Business Mailing Address
First Line	:	2111 4TH ST
Second Line	:
City	:	NEPTUNE BEACH
State	:	FL
Zip	:	32266-4733
Country	:	US
Telephone Number	:	904-465-4503
Fax Number	:	904-853-6285

Provider Business Practice Location Address
First Line	:	324 6TH AVE N
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-5726
Country	:	US
Telephone Number	:	904-465-4503
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2010
Last Update Date	:	03/05/2013

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