Provider Demographics
NPI:1487498317
Name:TINSLEY, LILLIAN J (RMHI)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:J
Last Name:TINSLEY
Suffix:
Gender:F
Credentials:RMHI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5311 GEORGIA PEACH AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-7534
Mailing Address - Country:US
Mailing Address - Phone:386-506-9591
Mailing Address - Fax:
Practice Address - Street 1:533 N NOVA RD STE 114
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-4421
Practice Address - Country:US
Practice Address - Phone:386-227-7014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL720599101YS0200X
FL25639101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool