Provider Demographics
NPI:1659823961
Name:STOKES, TANNICA LAVONE (LCPC)
Entity Type:Individual
Prefix:
First Name:TANNICA
Middle Name:LAVONE
Last Name:STOKES
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-5633
Mailing Address - Country:US
Mailing Address - Phone:410-837-3977
Mailing Address - Fax:
Practice Address - Street 1:1107 N POINT BLVD STE 205
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-3401
Practice Address - Country:US
Practice Address - Phone:410-284-3070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC7416101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD13919520OtherCAQH