Provider Demographics
NPI:1275015695
Name:ROBINSON, TIARA LA'DEIDRE (MEDU, LPC-R)
Entity Type:Individual
Prefix:MRS
First Name:TIARA
Middle Name:LA'DEIDRE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MEDU, LPC-R
Other - Prefix:
Other - First Name:TIARA
Other - Middle Name:LA'DEIDRE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4539 ALLIANCE WAY
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-3915
Mailing Address - Country:US
Mailing Address - Phone:267-334-7931
Mailing Address - Fax:
Practice Address - Street 1:4539 ALLIANCE WAY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-3915
Practice Address - Country:US
Practice Address - Phone:267-334-7931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-01
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704011436101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor