Basic Information
| Provider Information | |||||||||
| NPI: | 1215352414 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TINGLE-SHIRK | ||||||||
| FirstName: | WENDY | ||||||||
| MiddleName: | WAYNA | ||||||||
| NamePrefix: | |||||||||
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| Credential: | LGSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 249 | ||||||||
| Address2: | |||||||||
| City: | SNOW HILL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218630249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106321100 | ||||||||
| FaxNumber: | 4106325682 | ||||||||
| Practice Location | |||||||||
| Address1: | 6040 PUBLIC LANDING RD | ||||||||
| Address2: | |||||||||
| City: | SNOW HILL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218632453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106321100 | ||||||||
| FaxNumber: | 4106325682 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2014 | ||||||||
| LastUpdateDate: | 05/09/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.