Provider Demographics
NPI:1669849543
Name:DAUGHERTY, TIERZAH (LMHC)
Entity Type:Individual
Prefix:
First Name:TIERZAH
Middle Name:
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:TIERZAH
Other - Middle Name:
Other - Last Name:FAULKNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:16 DANE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-4534
Mailing Address - Country:US
Mailing Address - Phone:978-893-8667
Mailing Address - Fax:
Practice Address - Street 1:900 CUMMINGS CTR
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6198
Practice Address - Country:US
Practice Address - Phone:978-922-2280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-27
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health