| Doctor Name: | MS. TISHA LEA GENTRY |
| NPI Number: | 1033251368 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA LCPC |
| License Number: | LCPC 1953 |
| Business Practice Address: | 303 International Cir Suite T-125 Hunt Valley, MD - 210301464 |
| Business Phone Number: | 4437970144 |
| Business Fax Number: | |
| Mailing Address: | 203 H Yorkshire Way, BEL AIR |
| State: | MD |
| Postal Code: | 21014 |
| Phone Number: | 4104207155 |
| Fax Number: | |
| NPI Enumeration Date: | 02/13/2007 |
| NPI Last Update Date: | 03/26/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | LCPC 1953 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |