Provider Demographics
NPI:1427411529
Name:TINSLEY, YOLANDA D (LCDCIII)
Entity Type:Individual
Prefix:MS
First Name:YOLANDA
Middle Name:D
Last Name:TINSLEY
Suffix:
Gender:F
Credentials:LCDCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 SALEM AVE APT 3D
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-5102
Mailing Address - Country:US
Mailing Address - Phone:937-901-7408
Mailing Address - Fax:
Practice Address - Street 1:1102 SALEM AVE APT 3D
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-5102
Practice Address - Country:US
Practice Address - Phone:937-901-7408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH091067101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH091067OtherCHEMOICAL DEPENDENCY LICENSE