Provider Demographics
NPI:1124190434
Name:TIERNEY, TERRENCE ANDREW (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERRENCE
Middle Name:ANDREW
Last Name:TIERNEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 VENTURE LN
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23664-2071
Mailing Address - Country:US
Mailing Address - Phone:757-850-1292
Mailing Address - Fax:
Practice Address - Street 1:45 PINE ST
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23665-2025
Practice Address - Country:US
Practice Address - Phone:757-764-9580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001548103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical