Healthcare Provider Details

I. General information

NPI: 1003230244
Provider Name (Legal Business Name): TINA PRESBERY LPC, RN, CAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2014
Last Update Date: 12/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 UNRUH AVE
PHILADELPHIA PA
19149-2525
US

IV. Provider business mailing address

2805 UNRUH AVE
PHILADELPHIA PA
19149-2525
US

V. Phone/Fax

Practice location:
  • Phone: 267-593-9780
  • Fax:
Mailing address:
  • Phone: 267-593-9780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberPC010357
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN564935
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN564935
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC010357
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: