Provider Demographics
NPI:1053640284
Name:TINKER, MARLON RICHARD (LCSWC, CAC-AD)
Entity Type:Individual
Prefix:MR
First Name:MARLON
Middle Name:RICHARD
Last Name:TINKER
Suffix:
Gender:M
Credentials:LCSWC, CAC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 YORK ROAD
Mailing Address - Street 2:SUITE 109A
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-2028
Mailing Address - Country:US
Mailing Address - Phone:410-689-8757
Mailing Address - Fax:
Practice Address - Street 1:6600 YORK ROAD
Practice Address - Street 2:SUITE 109A
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-2028
Practice Address - Country:US
Practice Address - Phone:410-689-8757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-17
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC1591101YA0400X
MD138221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD324303600Medicaid