Provider Demographics
NPI:1972152668
Name:CHANCE, TAMMY J (RBT)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:J
Last Name:CHANCE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3324 HAMPTON CT
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-3203
Mailing Address - Country:US
Mailing Address - Phone:856-392-5155
Mailing Address - Fax:
Practice Address - Street 1:1651 OLD MEADOW RD STE 600
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-4389
Practice Address - Country:US
Practice Address - Phone:703-506-0123
Practice Address - Fax:866-857-0249
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ19-97589106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician