Provider Demographics
NPI:1013492107
Name:NANCE, TYRONE JR
Entity Type:Individual
Prefix:
First Name:TYRONE
Middle Name:
Last Name:NANCE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-1736
Mailing Address - Country:US
Mailing Address - Phone:443-982-0571
Mailing Address - Fax:
Practice Address - Street 1:1612 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-1736
Practice Address - Country:US
Practice Address - Phone:443-982-0571
Practice Address - Fax:443-267-0054
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health