Provider Demographics
NPI:1083967350
Name:PARKER, TIARA (MA)
Entity Type:Individual
Prefix:
First Name:TIARA
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:TIARA
Other - Middle Name:
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:514 EDWINSTOWE AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-1163
Mailing Address - Country:US
Mailing Address - Phone:910-583-5995
Mailing Address - Fax:
Practice Address - Street 1:6885 CLIFFDALE RD STE 202
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-2834
Practice Address - Country:US
Practice Address - Phone:910-339-0400
Practice Address - Fax:910-339-0396
Is Sole Proprietor?:No
Enumeration Date:2012-10-23
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16812101YP2500X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional