Provider Demographics
NPI:1326911868
Name:CLAROS TINEO, MARIANA JACKELIN
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:JACKELIN
Last Name:CLAROS TINEO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-4716
Mailing Address - Country:US
Mailing Address - Phone:571-494-6039
Mailing Address - Fax:
Practice Address - Street 1:232 CEDAR LODGE RD
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-6143
Practice Address - Country:US
Practice Address - Phone:336-474-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-29
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000048124496106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician