Provider Demographics
NPI:1750066007
Name:FLOWERS, TANYA JOY
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:JOY
Last Name:FLOWERS
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 1:5536 SHALLOW RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-1567
Mailing Address - Country:US
Mailing Address - Phone:301-943-9979
Mailing Address - Fax:
Practice Address - Street 1:5536 SHALLOW RIVER RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1567
Practice Address - Country:US
Practice Address - Phone:301-943-9979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLMSW22576104100000X
DCLG102097104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker