Provider Demographics
NPI:1053747147
Name:HINCKLE, TANYA ROSE (LPC, LCASA)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:ROSE
Last Name:HINCKLE
Suffix:
Gender:F
Credentials:LPC, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 CARDEN PL APT A
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-6080
Mailing Address - Country:US
Mailing Address - Phone:919-423-6649
Mailing Address - Fax:
Practice Address - Street 1:153 CARDEN PL APT A
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-6080
Practice Address - Country:US
Practice Address - Phone:919-423-6649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-20
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-3570101YA0400X
NC10445101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)