Provider Demographics
NPI:1073223491
Name:HARP, TIERRA (LCSW)
Entity Type:Individual
Prefix:
First Name:TIERRA
Middle Name:
Last Name:HARP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 EMPORIA LOOP
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-6842
Mailing Address - Country:US
Mailing Address - Phone:770-853-6963
Mailing Address - Fax:
Practice Address - Street 1:117 EMPORIA LOOP
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-6842
Practice Address - Country:US
Practice Address - Phone:770-853-6963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0078381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty