Individual
TUAN TA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2415 W LAFAYETTE AVE, BALTIMORE, MD 21216-4804
(443) 403-9079
Mailing address
2415 W LAFAYETTE AVE, BALTIMORE, MD 21216-4804
(443) 403-9079
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
R212734
MD
Other
Enumeration date
06/06/2023
Last updated
06/06/2023
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