Provider Demographics
NPI:1386217156
Name:ANDERSON, TIARA (LCSW-C)
Entity Type:Individual
Prefix:
First Name:TIARA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10201 GOOSECREEK CT
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-5847
Mailing Address - Country:US
Mailing Address - Phone:843-298-2070
Mailing Address - Fax:
Practice Address - Street 1:10201 GOOSECREEK CT
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-5847
Practice Address - Country:US
Practice Address - Phone:843-298-2070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD219961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty