Provider Demographics
NPI:1427890920
Name:CROOM, TINESHA L (MS)
Entity type:Individual
Prefix:
First Name:TINESHA
Middle Name:L
Last Name:CROOM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 MISTY GLEN CIR
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-8153
Mailing Address - Country:US
Mailing Address - Phone:803-807-3778
Mailing Address - Fax:
Practice Address - Street 1:104 MISTY GLEN CIR
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-8153
Practice Address - Country:US
Practice Address - Phone:803-807-3778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional