Provider Demographics
NPI:1659906956
Name:VENABLE, TIERRA (RBT)
Entity Type:Individual
Prefix:
First Name:TIERRA
Middle Name:
Last Name:VENABLE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 2ND ST SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4725
Mailing Address - Country:US
Mailing Address - Phone:540-404-1189
Mailing Address - Fax:540-904-0096
Practice Address - Street 1:1138 2ND ST SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4725
Practice Address - Country:US
Practice Address - Phone:540-404-1189
Practice Address - Fax:540-904-0096
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-19-77732106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician