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General NPI Number Information
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NPI Number | 1033171061
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Entity Type | Individual
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Provider Name | SUSAN ANN TANGIRES LCPC LCADC
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Gender | Female
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Dates
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Enumeration Date | 04/05/2006
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Last Update Date | 11/14/2016
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Provider Practice Location Address
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Address Line | 800 INGLESIDE AVE
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City | CATONSVILLE
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State | MD
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Zip | 21228-1722
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Country | US
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Telephone | 410-744-5937
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Fax | 410-744-9423
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Provider Business Mailing Address
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Address Line | 3134 CHATHAM CT
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City | ELLICOTT CITY
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State | MD
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Zip | 21042-2410
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Country | US
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Telephone | 410-465-8448
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Fax | 410-744-9423
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCA343
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LC1260
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License Number State | MD
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