Provider Demographics
NPI:1730649922
Name:TOLLENGER, BARRETT ARTHUR (ADT)
Entity Type:Individual
Prefix:MR
First Name:BARRETT
Middle Name:ARTHUR
Last Name:TOLLENGER
Suffix:
Gender:M
Credentials:ADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 MOUNTAIN ROAD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122
Mailing Address - Country:US
Mailing Address - Phone:443-548-3733
Mailing Address - Fax:
Practice Address - Street 1:2825 MOUNTAIN ROAD
Practice Address - Street 2:SUITE 204
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122
Practice Address - Country:US
Practice Address - Phone:443-548-3733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDADT1906101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1851838643Medicaid