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General NPI Number Information
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NPI Number | 1851062707
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Entity Type | Individual
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Provider Name | TABITHA MILLWOOD LPC
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Gender | Female
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Dates
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Enumeration Date | 09/21/2021
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Last Update Date | 02/23/2024
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Provider Practice Location Address
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Address Line | 45 CAMBRIDGE CT
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City | WETUMPKA
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State | AL
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Zip | 36093-1261
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Country | US
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Telephone | 334-839-1891
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Fax |
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Provider Business Mailing Address
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Address Line | 406 FAIRVIEW AVE
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City | PRATTVILLE
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State | AL
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Zip | 36066-5210
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Country | US
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Telephone | 334-467-5997
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 4210
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License Number State | AL
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