Provider Demographics
NPI:1114478732
Name:DELOATCH, TIA M (LCSW-C)
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:M
Last Name:DELOATCH
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 CARROLL ST STE 101
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-5986
Mailing Address - Country:US
Mailing Address - Phone:301-247-1120
Mailing Address - Fax:
Practice Address - Street 1:401 CARROLL ST STE 101
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-5986
Practice Address - Country:US
Practice Address - Phone:301-247-1120
Practice Address - Fax:240-776-4462
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-19
Last Update Date:2023-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD217131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical