Provider Demographics
NPI:1629831409
Name:COLE, TIERRA MONIQUE
Entity Type:Individual
Prefix:
First Name:TIERRA
Middle Name:MONIQUE
Last Name:COLE
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 1:5180 CLACTON AVE
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-3828
Mailing Address - Country:US
Mailing Address - Phone:240-579-8646
Mailing Address - Fax:
Practice Address - Street 1:1003 W 7TH ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4106
Practice Address - Country:US
Practice Address - Phone:301-245-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110710104100000X
MD30299104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker