Provider Demographics
NPI:1801382130
Name:PLEASANT, TAMARA D (LCPC,MA)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:D
Last Name:PLEASANT
Suffix:
Gender:F
Credentials:LCPC,MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9811 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20886-4266
Mailing Address - Country:US
Mailing Address - Phone:210-441-0073
Mailing Address - Fax:
Practice Address - Street 1:9811 LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20886-4266
Practice Address - Country:US
Practice Address - Phone:210-441-0073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-10
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC9554101YM0800X
MD8442101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty