Healthcare Provider Details

I. General information

NPI: 1619814456
Provider Name (Legal Business Name): TABITHA ROMINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4798 1ST AVE S STE 103
PELL CITY AL
35125-7403
US

IV. Provider business mailing address

4798 1ST AVE S STE 103
PELL CITY AL
35125-7403
US

V. Phone/Fax

Practice location:
  • Phone: 205-259-6838
  • Fax:
Mailing address:
  • Phone: 205-259-6838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberALC05752
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: