Provider Demographics
NPI:1568009405
Name:SMITH, TIA ROJAUNDA
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:ROJAUNDA
Last Name:SMITH
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 1:222 FIRST STREET APT B
Mailing Address - Street 2:222 FIRST STREET APT B
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70364
Mailing Address - Country:US
Mailing Address - Phone:985-601-1664
Mailing Address - Fax:
Practice Address - Street 1:222 FIRST ST APT B
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70364-3204
Practice Address - Country:US
Practice Address - Phone:985-601-1664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty