Provider Demographics
NPI:1720890676
Name:TINNEY, DELONDA MONEA
Entity type:Individual
Prefix:
First Name:DELONDA
Middle Name:MONEA
Last Name:TINNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 GLEN RD
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-7943
Mailing Address - Country:US
Mailing Address - Phone:919-636-9966
Mailing Address - Fax:
Practice Address - Street 1:65 GLEN RD
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-7943
Practice Address - Country:US
Practice Address - Phone:919-636-9988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician