Individual
TABITHA GRANT DIMINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMFT, MCAP, ICRC-ADA
Contact information
Practice address
1717 20TH ST STE 102, VERO BEACH, FL 32960-0619
(772) 584-2501
Mailing address
1717 20TH ST STE 102, VERO BEACH, FL 32960-0619
(772) 584-2501
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
ADC-010451-2015
FL
101YM0800X
Mental Health Counselor
IMH10719
FL
106H00000X
Marriage & Family Therapist
Primary
MT3149
FL
Other
Enumeration date
04/24/2012
Last updated
08/14/2022
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