Provider Demographics
NPI:1821048174
Name:PIERCE, TARA M (LMFT)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:M
Last Name:PIERCE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 301
Mailing Address - Street 2:
Mailing Address - City:WENTWORTH
Mailing Address - State:NC
Mailing Address - Zip Code:27375-0301
Mailing Address - Country:US
Mailing Address - Phone:336-342-5756
Mailing Address - Fax:336-349-1115
Practice Address - Street 1:335 COUNTY HOME ROAD
Practice Address - Street 2:
Practice Address - City:WENTWORTH
Practice Address - State:NC
Practice Address - Zip Code:27375-0301
Practice Address - Country:US
Practice Address - Phone:336-342-5756
Practice Address - Fax:336-349-1115
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1108106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6105221Medicaid