Healthcare Provider Details

I. General information

NPI: 1861006793
Provider Name (Legal Business Name): TATYANA M HENRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7477 BALTIMORE ANNAPOLIS BLVD STE 201
GLEN BURNIE MD
21061-3567
US

IV. Provider business mailing address

1115 HANCOCK ST
BROOKLYN NY
11221-5118
US

V. Phone/Fax

Practice location:
  • Phone: 301-444-5001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP17929
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: