Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 000801 | NY |
N | 101YP2500X | Professional Counselor | 000801 | NY |
N | 102L00000X | Psychologist | 000801 | NY |
N | 103T00000X | Psychologist | 000801 | NY |
N | 103TC1900X | Counseling Psychologist | 000801 | NY |
N | 103TP2701X | Group Psychotherapist | 000801 | NY |
NPI | 1073523890 |
---|---|
Provider Name | Ms. Heddie Tracy Tinker |
First Address | New York, NY 10024-2952 |
Second Address | New York, NY 10001-3006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 08/07/2007 |