Provider Demographics
NPI:1093283434
Name:COUCH, TIERA T
Entity Type:Individual
Prefix:
First Name:TIERA
Middle Name:T
Last Name:COUCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3048 BRIARCLIFF RD NE APT 5
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2693
Mailing Address - Country:US
Mailing Address - Phone:313-812-7728
Mailing Address - Fax:
Practice Address - Street 1:3048 BRIARCLIFF RD NE APT 5
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2693
Practice Address - Country:US
Practice Address - Phone:313-812-7728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-04
Last Update Date:2018-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008496104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker