Provider Demographics
NPI:1669931226
Name:HALYARD, TASHICA MONIQUE (LCPC)
Entity type:Individual
Prefix:MISS
First Name:TASHICA
Middle Name:MONIQUE
Last Name:HALYARD
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 1:2415 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-5017
Mailing Address - Country:US
Mailing Address - Phone:281-508-3604
Mailing Address - Fax:
Practice Address - Street 1:2415 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5017
Practice Address - Country:US
Practice Address - Phone:281-417-8427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-13
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC3123101YA0400X
TX44846101YA0400X
TX87418101YP2500X
MI6401222375101YP2500X
MDLC10959101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional