Provider Demographics
NPI:1255911194
Name:START, TAMMY ANNE
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:ANNE
Last Name:START
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:A
Other - Last Name:START
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, ADC IP
Mailing Address - Street 1:104 GEORGE BISHOP PKWY
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-7335
Mailing Address - Country:US
Mailing Address - Phone:843-903-6212
Mailing Address - Fax:
Practice Address - Street 1:104 GEORGE BISHOP PKWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-7335
Practice Address - Country:US
Practice Address - Phone:843-903-6212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-14
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCADC-2092101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty