Provider Demographics
NPI:1659965374
Name:KINSEY, TAMMY LEE (CAC-AD)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:LEE
Last Name:KINSEY
Suffix:
Gender:F
Credentials:CAC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 N POTOMAC ST STE 101-102
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-4855
Mailing Address - Country:US
Mailing Address - Phone:240-513-6001
Mailing Address - Fax:240-513-6122
Practice Address - Street 1:44 N POTOMAC ST
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-4855
Practice Address - Country:US
Practice Address - Phone:240-513-6001
Practice Address - Fax:240-513-6122
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC2484101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)