Provider Demographics
NPI:1225913585
Name:TOLBERT, TISHAUANA SINAE
Entity type:Individual
Prefix:
First Name:TISHAUANA
Middle Name:SINAE
Last Name:TOLBERT
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 1:30500 HICKORY RD APT 107
Mailing Address - Street 2:
Mailing Address - City:PRINCESS ANNE
Mailing Address - State:MD
Mailing Address - Zip Code:21853-3429
Mailing Address - Country:US
Mailing Address - Phone:410-726-8181
Mailing Address - Fax:
Practice Address - Street 1:30500 HICKORY RD APT 107
Practice Address - Street 2:
Practice Address - City:PRINCESS ANNE
Practice Address - State:MD
Practice Address - Zip Code:21853-3429
Practice Address - Country:US
Practice Address - Phone:410-726-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-06
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician