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General NPI Number Information
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NPI Number | 1174837926
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Entity Type | Individual
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Provider Name | VIRGINIA DARLENE TACKETT LMFTA
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Gender | Female
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Dates
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Enumeration Date | 08/04/2010
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Last Update Date | 08/04/2010
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Provider Practice Location Address
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Address Line | 1919 STATE ST SUITE 322
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City | NEW ALBANY
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State | IN
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Zip | 47150-4929
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Country | US
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Telephone | 812-944-2532
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Fax |
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Provider Business Mailing Address
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Address Line | 102 N HARRISON ST
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City | SALEM
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State | IN
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Zip | 47167-1426
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Country | US
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Telephone | 812-528-0845
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 85000058A
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License Number State | IN
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