Provider Demographics
NPI:1871321711
Name:TABOR, JESSICA (PHD, LPC, LCADC,)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:TABOR
Suffix:
Gender:F
Credentials:PHD, LPC, LCADC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 WINTERBERRY RD
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-4900
Mailing Address - Country:US
Mailing Address - Phone:908-328-5207
Mailing Address - Fax:
Practice Address - Street 1:22 WINTERBERRY RD
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-4900
Practice Address - Country:US
Practice Address - Phone:908-328-5207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00205400101YA0400X
NJ37PC00523200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)