Provider Demographics
NPI:1215267877
Name:WAYNE, TAMIKA A
Entity type:Individual
Prefix:MRS
First Name:TAMIKA
Middle Name:A
Last Name:WAYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TAMIKA
Other - Middle Name:A
Other - Last Name:WAYNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:1114 STONEYBROOK LN
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-5218
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:85 OLD EAGLE SCHOOL RD STE 200
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-2556
Practice Address - Country:US
Practice Address - Phone:610-368-3946
Practice Address - Fax:610-368-3946
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
PA000000000000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA22000021053-091OtherROCKPORT INSURANCE