MEDICARE: MS. TABITHA THURSTON 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-190341	OH

General Provider Information

NPI Number	:	1346059466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TABITHA THURSTON CDCA

Provider Business Mailing Address
First Line	:	363 S BURNETT RD
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45505-2628
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3184 W BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43204-1327
Country	:	US
Telephone Number	:	937-721-4004
Fax Number	:

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

Provider Enumeration Date	:	01/03/2025
Last Update Date	:	01/03/2025

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