Provider Demographics
NPI:1235405937
Name:FORD ROMES, TARA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:
Last Name:FORD ROMES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:FORD ROMES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CADC
Mailing Address - Street 1:300 EAST HOSPITAL RD BLD 300
Mailing Address - Street 2:
Mailing Address - City:FORT EISENHOWER
Mailing Address - State:GA
Mailing Address - Zip Code:30905
Mailing Address - Country:US
Mailing Address - Phone:706-787-2734
Mailing Address - Fax:
Practice Address - Street 1:213 ACADEMIC DR
Practice Address - Street 2:
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5932
Practice Address - Country:US
Practice Address - Phone:706-787-2254
Practice Address - Fax:706-787-8286
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA429101YA0400X
GAMSW005278104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)