MEDICARE: BOBBI LAVONNE TUBBS CDCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDCA.185905	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033857487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BOBBI LAVONNE TUBBS CDCA

Provider Business Mailing Address
First Line	:	2211 LAKE CLUB DR STE 105
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-3204
Country	:	US
Telephone Number	:	614-805-2995
Fax Number	:

Provider Business Practice Location Address
First Line	:	2211 LAKE CLUB DR STE 105
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-3204
Country	:	US
Telephone Number	:	614-805-2995
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2022
Last Update Date	:	02/29/2024

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