Provider Demographics
NPI:1104134105
Name:LINGLE, TERRY DEAN (CSC)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:DEAN
Last Name:LINGLE
Suffix:
Gender:M
Credentials:CSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 BAY ST STE 307
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-2796
Mailing Address - Country:US
Mailing Address - Phone:410-822-5142
Mailing Address - Fax:410-819-0591
Practice Address - Street 1:301 BAY ST STE 307
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-2796
Practice Address - Country:US
Practice Address - Phone:410-822-5142
Practice Address - Fax:410-819-0591
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSC1009101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)