Provider Demographics
NPI:1598397416
Name:MACZIS, TINA (LGPC)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:
Last Name:MACZIS
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 W 27TH ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-3001
Mailing Address - Country:US
Mailing Address - Phone:240-285-1875
Mailing Address - Fax:
Practice Address - Street 1:1777 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-1380
Practice Address - Country:US
Practice Address - Phone:410-395-4085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-08
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDATG276101Y00000X
MDLC12082101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor