Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ||
Y | 103G00000X | Clinical Psychologist | 06152 | MD |
Y | 103TC0700X | Clinical Psychologist | 06152 | MD |
N | 103TH0004X | Health Psychologist |
NPI | 1295238707 |
---|---|
Provider Name | Dr. Shayla T'nai Thrash |
First Address | Baltimore, MD 21201-1524 |
Second Address | Baltimore, MD 21201-1524 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2018 |
Last Update Date | 01/10/2018 |