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NPI Code Detail

MEDICARE: TONYA GULLEDGE HERBOLD LPC

MEDICARE: TONYA GULLEDGE HERBOLD LPC
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
1101YP2500XProfessional Counselor3811AL

General Provider Information

NPI Number : 1306350343
Entity Type Code : Individual
Provider Name (Legal Business Name) : TONYA GULLEDGE HERBOLD LPC
Provider Business Mailing Address
First Line : PO BOX 1245
Second Line :
City : DOTHAN
State : AL
Zip : 36302-1245
Country : US
Telephone Number : 334-712-2720
Fax Number :
Provider Business Practice Location Address
First Line : 1672 COLUMBIA HWY
Second Line :
City : DOTHAN
State : AL
Zip : 36303-5434
Country : US
Telephone Number : 334-790-7025
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2017
Last Update Date : 11/29/2017

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