Provider Demographics
NPI:1699014357
Name:BAUBLITZ, TINA M (LCPC)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:BAUBLITZ
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 1:11155 STRATFIELD COURT
Mailing Address - Street 2:
Mailing Address - City:MARRIOTTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21104
Mailing Address - Country:US
Mailing Address - Phone:410-970-2328
Mailing Address - Fax:
Practice Address - Street 1:11155 STRATFIELD CT
Practice Address - Street 2:
Practice Address - City:MARRIOTTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21104-1650
Practice Address - Country:US
Practice Address - Phone:410-970-2328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4865101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional