Organization
HOUSE OF TABITHA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
QUENESHIA TILLMAN (MANAGER)
(702) 913-2703
Entity
Organization
Contact information
Practice address
6802 S 42ND ST, PHOENIX, AZ 85042-5206
(702) 913-2703
Mailing address
6802 S 42ND ST, PHOENIX, AZ 85042-5206
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
03/17/2021
Last updated
03/17/2021
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