Provider Demographics
NPI:1336215375
Name:ROLAND, TAMIKA (LCPC)
Entity Type:Individual
Prefix:
First Name:TAMIKA
Middle Name:
Last Name:ROLAND
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 E NORTHERN PKWY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-1920
Mailing Address - Country:US
Mailing Address - Phone:443-668-7840
Mailing Address - Fax:
Practice Address - Street 1:122 WEBER ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-4106
Practice Address - Country:US
Practice Address - Phone:410-752-5525
Practice Address - Fax:410-752-5531
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD000495101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD64758501OtherBCBS MD. RENDERING PRV #
MDKC29UNOtherCAREFIRST PROV #
MDT5140018OtherREGIONAL BLUE CHOIC PRV #