Provider Demographics
NPI:1477014033
Name:TILGHMAN, TAWANNA
Entity Type:Individual
Prefix:
First Name:TAWANNA
Middle Name:
Last Name:TILGHMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8248 KINGS CROWN RD
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-2364
Mailing Address - Country:US
Mailing Address - Phone:443-880-6199
Mailing Address - Fax:
Practice Address - Street 1:5411 OLD FREDERICK RD STE 13AND14
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-2195
Practice Address - Country:US
Practice Address - Phone:410-744-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD168921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical