Provider Demographics
NPI:1467820027
Name:NIGHTINGALE, TINA LYNNE (LCPCCC)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:LYNNE
Last Name:NIGHTINGALE
Suffix:
Gender:F
Credentials:LCPCCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 TRAILSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-1663
Mailing Address - Country:US
Mailing Address - Phone:207-949-0970
Mailing Address - Fax:
Practice Address - Street 1:31 TRAILSIDE CIR
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-1663
Practice Address - Country:US
Practice Address - Phone:207-949-0970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4529101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health