Provider Demographics
NPI:1487713244
Name:STICKLEY, TINA (LCPC)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:STICKLEY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15601 CRESAP MILL RD SE
Mailing Address - Street 2:
Mailing Address - City:OLDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21555-1337
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:81 BALTIMORE ST
Practice Address - Street 2:SUITE 606
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3008
Practice Address - Country:US
Practice Address - Phone:301-268-9767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional