Provider Demographics
NPI:1821340175
Name:ALEXANDER, TIA GOLDEN
Entity Type:Individual
Prefix:MRS
First Name:TIA
Middle Name:GOLDEN
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:TIA
Other - Middle Name:CHERISE
Other - Last Name:GOLDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1460 DEBBS LN
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-8205
Mailing Address - Country:US
Mailing Address - Phone:704-369-4059
Mailing Address - Fax:
Practice Address - Street 1:2708 NE 14TH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-3565
Practice Address - Country:US
Practice Address - Phone:888-880-9270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist