Provider Demographics
NPI:1255673166
Name:TINSLEY, RONDA B (CAC - AD)
Entity Type:Individual
Prefix:MRS
First Name:RONDA
Middle Name:B
Last Name:TINSLEY
Suffix:
Gender:F
Credentials:CAC - AD
Other - Prefix:
Other - First Name:RONDA
Other - Middle Name:B
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CAC - AD
Mailing Address - Street 1:122 LANGLEY ROAD NORTH
Mailing Address - Street 2:SUITE B
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-6539
Mailing Address - Country:US
Mailing Address - Phone:410-222-0100
Mailing Address - Fax:410-222-0116
Practice Address - Street 1:122 LANGLEY ROAD NORTH
Practice Address - Street 2:SUITE B
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060-6539
Practice Address - Country:US
Practice Address - Phone:410-222-0100
Practice Address - Fax:410-222-0116
Is Sole Proprietor?:No
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC0439101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)