Provider Demographics
NPI:1356229389
Name:BENTLEY, TANGIELA MICHELLE
Entity type:Individual
Prefix:
First Name:TANGIELA
Middle Name:MICHELLE
Last Name:BENTLEY
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 1:4308 HARFORD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-3116
Mailing Address - Country:US
Mailing Address - Phone:410-426-5650
Mailing Address - Fax:410-426-5143
Practice Address - Street 1:4308 HARFORD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-3116
Practice Address - Country:US
Practice Address - Phone:410-426-5650
Practice Address - Fax:410-426-5143
Is Sole Proprietor?:No
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16248101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health