Provider Demographics
NPI:1932816477
Name:CORBETT-JONES, TISHA LANETTE
Entity Type:Individual
Prefix:
First Name:TISHA
Middle Name:LANETTE
Last Name:CORBETT-JONES
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 1:3410 BRINKLEY RD APT 303
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-7112
Mailing Address - Country:US
Mailing Address - Phone:301-437-3524
Mailing Address - Fax:
Practice Address - Street 1:3410 BRINKLEY RD APT 303
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-7112
Practice Address - Country:US
Practice Address - Phone:301-437-3524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty