Provider Demographics
NPI:1861854416
Name:TINKLENBERG, MICHAEL I (MAED, CSAC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:TINKLENBERG
Suffix:I
Gender:M
Credentials:MAED, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 RIVER BEND RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-2981
Mailing Address - Country:US
Mailing Address - Phone:910-347-3065
Mailing Address - Fax:910-347-3065
Practice Address - Street 1:237 RIVER BEND RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-2981
Practice Address - Country:US
Practice Address - Phone:910-347-3065
Practice Address - Fax:910-347-3065
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCSAC-20494101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)