Provider Demographics
NPI:1366225104
Name:WRIGHT, TANYA (ADDICTION COUNSELOR)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:ADDICTION COUNSELOR
Other - Prefix:
Other - First Name:VONZELLA
Other - Middle Name:MAE
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ADDICTION SUPERVISOR
Mailing Address - Street 1:1209 N LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21213-3834
Mailing Address - Country:US
Mailing Address - Phone:202-381-4307
Mailing Address - Fax:
Practice Address - Street 1:1209 N LINWOOD AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21213-3834
Practice Address - Country:US
Practice Address - Phone:202-381-4307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC2524101YA0400X
MD1433101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)