Healthcare Provider Details

I. General information

NPI: 1205764693
Provider Name (Legal Business Name): TONISHA PATTERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7038 BELCLARE RD
DUNDALK MD
21222-5904
US

IV. Provider business mailing address

7038 BELCLARE RD
DUNDALK MD
21222-5904
US

V. Phone/Fax

Practice location:
  • Phone: 443-622-5533
  • Fax:
Mailing address:
  • Phone: 443-622-5533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLGP17558
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: