| Doctor Name: | TABITHA FONDREN |
| NPI Number: | 1023448479 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 3900 Armour Ave Fort Smith, AR - 729044317 |
| Business Phone Number: | 4797838849 |
| Business Fax Number: | 4797831914 |
| Mailing Address: | 3900 Armour Ave, FORT SMITH |
| State: | AR |
| Postal Code: | 729044317 |
| Phone Number: | 4797838849 |
| Fax Number: | 4797831914 |
| NPI Enumeration Date: | 11/22/2013 |
| NPI Last Update Date: | 11/22/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |