Provider Demographics
NPI:1184034381
Name:PIERRE, TISHA
Entity Type:Individual
Prefix:
First Name:TISHA
Middle Name:
Last Name:PIERRE
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 1:700 S ROYAL POINCIANA BLVD STE 300
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6667
Mailing Address - Country:US
Mailing Address - Phone:305-668-9000
Mailing Address - Fax:
Practice Address - Street 1:700 S ROYAL POINCIANA BLVD STE 300
Practice Address - Street 2:SUITE 300
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-6667
Practice Address - Country:US
Practice Address - Phone:305-668-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW109491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical