Provider Demographics
NPI:1578102174
Name:BOULWARE STACKHOUSE, TONI ALLAYNE
Entity Type:Individual
Prefix:DR
First Name:TONI
Middle Name:ALLAYNE
Last Name:BOULWARE STACKHOUSE
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 1:304 TECUMSEH WAY
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-2870
Mailing Address - Country:US
Mailing Address - Phone:443-226-5495
Mailing Address - Fax:
Practice Address - Street 1:304 TECUMSEH WAY
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-2870
Practice Address - Country:US
Practice Address - Phone:443-226-5495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health