Provider Demographics
NPI:1417514381
Name:BROWN, TINA LESHELLE (LCSW-C, MAC, CSC-AD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:LESHELLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCSW-C, MAC, CSC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5527 WHITWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-3749
Mailing Address - Country:US
Mailing Address - Phone:443-610-9287
Mailing Address - Fax:410-488-5424
Practice Address - Street 1:5209 YORK ROAD
Practice Address - Street 2:SUITE 2
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212
Practice Address - Country:US
Practice Address - Phone:443-610-9287
Practice Address - Fax:410-488-5424
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-25
Last Update Date:2019-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD187381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical