Individual
SANDRA SUE TABOLT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC
Contact information
Practice address
7825 BALLANTYNE COMMONS PKWY, STE 110, CHARLOTTE, NC 28277-3174
(704) 446-0391
Mailing address
PO BOX 19305, CHARLOTTE, NC 28219-9305
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CSAC-1507
NC
Other
Enumeration date
08/22/2018
Last updated
07/15/2024
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