Healthcare Provider Details

I. General information

NPI: 1336032051
Provider Name (Legal Business Name): TABATHA WALFORD LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 GREEN RD STE N
ANN ARBOR MI
48105-2948
US

IV. Provider business mailing address

3901 SYLVAN LAKES BLVD APT 510
SYLVANIA OH
43560-8719
US

V. Phone/Fax

Practice location:
  • Phone: 248-573-7417
  • Fax:
Mailing address:
  • Phone: 775-219-3118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2507323
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451024327
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: