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General NPI Number Information
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NPI Number | 1316281587
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Entity Type | Individual
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Provider Name | TANYA CHARLES LCPC, NCC
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Gender | Female
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Dates
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Enumeration Date | 11/12/2012
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Last Update Date | 04/06/2022
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Provider Practice Location Address
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Address Line | 3739 WILKENS AVE
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City | BALTIMORE
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State | MD
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Zip | 21229-5035
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Country | US
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Telephone | 443-563-2203
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Fax |
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Provider Business Mailing Address
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Address Line | 3739 WILKENS AVE
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City | BALTIMORE
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State | MD
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Zip | 21229-5035
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Country | US
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Telephone | 410-929-3582
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Fax |
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | LC4420
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License Number State | MD
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