Provider Demographics
NPI:1548751472
Name:TINCKNELL, AMANDA R (MS, BCBA, LBA)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:R
Last Name:TINCKNELL
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 CASSANDRA DR UNIT 184
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6896
Mailing Address - Country:US
Mailing Address - Phone:267-377-7362
Mailing Address - Fax:
Practice Address - Street 1:23 THOMAS SHILLING CT
Practice Address - Street 2:
Practice Address - City:UPPERCO
Practice Address - State:MD
Practice Address - Zip Code:21155-9334
Practice Address - Country:US
Practice Address - Phone:267-377-7362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-26
Last Update Date:2019-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst