Basic Information
| Provider Information | |||||||||
| NPI: | 1629630603 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TABLER | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | AAS, QMHS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 915 S RIVERSIDE DR NE | ||||||||
| Address2: | |||||||||
| City: | MCCONNELSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437569102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7409626933 | ||||||||
| FaxNumber: | 7409626305 | ||||||||
| Practice Location | |||||||||
| Address1: | 915 S RIVERSIDE DR NE | ||||||||
| Address2: | |||||||||
| City: | MCCONNELSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437569102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7409625204 | ||||||||
| FaxNumber: | 7409623688 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2019 | ||||||||
| LastUpdateDate: | 01/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 101YA0400X | 179282 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.