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General NPI Number Information
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NPI Number | 1528725611
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Entity Type | Individual
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Provider Name | YASHIKA TIARA FOMBY LPC
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Gender | Female
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Dates
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Enumeration Date | 11/23/2021
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 216 E 15TH ST
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City | ANNISTON
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State | AL
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Zip | 36207-3804
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Country | US
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Telephone | 256-591-7758
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Fax |
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Provider Business Mailing Address
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Address Line | 1503 CAMELLIA CIR NE
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City | JACKSONVILLE
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State | AL
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Zip | 36265-9603
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Country | US
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Telephone | 256-591-7558
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC04498
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701015135
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License Number State | VA
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