Provider Demographics
NPI:1235537630
Name:TOTTEN, TIARA (LCMHC, LCAS)
Entity Type:Individual
Prefix:
First Name:TIARA
Middle Name:
Last Name:TOTTEN
Suffix:
Gender:F
Credentials:LCMHC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:669 SAGAMORE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27549
Mailing Address - Country:US
Mailing Address - Phone:252-477-0008
Mailing Address - Fax:252-303-0321
Practice Address - Street 1:669 SAGAMORE DR
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549
Practice Address - Country:US
Practice Address - Phone:252-477-0008
Practice Address - Fax:252-303-0321
Is Sole Proprietor?:No
Enumeration Date:2014-12-17
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20737101YA0400X
NC11295101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)