Provider Demographics
NPI:1285846709
Name:TIERNEY, EVANGELINE HARRIS (MSW -LICSW)
Entity Type:Individual
Prefix:MRS
First Name:EVANGELINE
Middle Name:HARRIS
Last Name:TIERNEY
Suffix:
Gender:F
Credentials:MSW -LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3167 WESTOVER DR.
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020
Mailing Address - Country:US
Mailing Address - Phone:202-575-3270
Mailing Address - Fax:
Practice Address - Street 1:1301 CONNECTICUT AVE. NW
Practice Address - Street 2:750
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036
Practice Address - Country:US
Practice Address - Phone:202-429-4935
Practice Address - Fax:202-429-0102
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3023831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical