MEDICARE: MS. ANN TINUS MA, MS, MAC, LCAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	945	NC
2	101YA0400X	Addiction (Substance Use Disorder) Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	9407152	OTHER		AETNA
3	148UG	OTHER	NC	BCBS

General Provider Information

NPI Number	:	1407025729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANN TINUS MA, MS, MAC, LCAS

Provider Business Mailing Address
First Line	:	409 ARROWOOD AVE
Second Line	:
City	:	LANCASTER
State	:	SC
Zip	:	29720-1503
Country	:	US
Telephone Number	:	908-533-5750
Fax Number	:

Provider Business Practice Location Address
First Line	:	5700 EXECUTIVE CENTER DR STE 110
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28212-8833
Country	:	US
Telephone Number	:	803-730-2282
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2008
Last Update Date	:	02/16/2025

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