| Doctor Name: | DR. TABITHA AILLENE GRESSARD |
| NPI Number: | 1013285121 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSYD |
| License Number: | 1725 |
| Business Practice Address: | 557 Glover Ave. Suite 3 Enterprise, AL - 363302070 |
| Business Phone Number: | 3344894448 |
| Business Fax Number: | 3343472919 |
| Mailing Address: | 557 Glover Ave., Suite 3 ENTERPRISE |
| State: | AL |
| Postal Code: | 363302070 |
| Phone Number: | 3344894448 |
| Fax Number: | 3343472919 |
| NPI Enumeration Date: | 12/02/2011 |
| NPI Last Update Date: | 11/24/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 1725 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |