Provider Demographics
NPI:1003230244
Name:PRESBERY, TINA (LPC, RN, CAADC)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:PRESBERY
Suffix:
Gender:F
Credentials:LPC, RN, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 UNRUH AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-2525
Mailing Address - Country:US
Mailing Address - Phone:267-593-9780
Mailing Address - Fax:
Practice Address - Street 1:2805 UNRUH AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-2525
Practice Address - Country:US
Practice Address - Phone:267-593-9780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-07
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC010357101YA0400X, 101YP2500X
PARN564935163W00000X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health