Healthcare Provider Details

I. General information

NPI: 1205411295
Provider Name (Legal Business Name): TABITHA LAUREN GOLDEN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2021
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PERIMETER PARK S STE 100N
BIRMINGHAM AL
35243-3248
US

IV. Provider business mailing address

1 PERIMETER PARK S STE 100N
BIRMINGHAM AL
35243-3248
US

V. Phone/Fax

Practice location:
  • Phone: 205-936-2356
  • Fax:
Mailing address:
  • Phone: 205-936-2356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4265
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: