Provider Demographics
NPI:1174837926
Name:TACKETT, VIRGINIA DARLENE (LMFTA)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:DARLENE
Last Name:TACKETT
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IN
Mailing Address - Zip Code:47167-1426
Mailing Address - Country:US
Mailing Address - Phone:812-528-0845
Mailing Address - Fax:
Practice Address - Street 1:1919 STATE ST
Practice Address - Street 2:SUITE 322
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4929
Practice Address - Country:US
Practice Address - Phone:812-944-2532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN85000058A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist