Provider Demographics
NPI:1306314315
Name:TAMALE, STANLEY (COUNSELOR)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:
Last Name:TAMALE
Suffix:
Gender:M
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9222 WEATHERVANE PL
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-1411
Mailing Address - Country:US
Mailing Address - Phone:972-795-0943
Mailing Address - Fax:
Practice Address - Street 1:2 TAFT STREET
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-2085
Practice Address - Country:US
Practice Address - Phone:838-410-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP7479101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor