Provider Demographics
NPI:1477112266
Name:CITIZEN, TARTIANA SHERRIE
Entity Type:Individual
Prefix:MRS
First Name:TARTIANA
Middle Name:SHERRIE
Last Name:CITIZEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 ST TITUS DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHURCH POINT
Mailing Address - State:LA
Mailing Address - Zip Code:70525
Mailing Address - Country:US
Mailing Address - Phone:337-418-5955
Mailing Address - Fax:
Practice Address - Street 1:123 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:GRAND COTEAU
Practice Address - State:LA
Practice Address - Zip Code:70541
Practice Address - Country:US
Practice Address - Phone:337-662-3737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14166104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker