Individual
TANYA Y PRINCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MHS, CAC-AD
Contact information
Practice address
2225 N CHARLES ST, BALTIMORE, MD 21218-5778
(443) 573-8673
(410) 243-8175
Mailing address
5620 WESLEY AVE, BALTIMORE, MD 21207-6827
(443) 760-2973
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
AC1790
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AC1790
BOARD LICENSE
MD
Enumeration date
09/28/2012
Last updated
09/28/2012
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