Provider Demographics
NPI:1821841255
Name:CLUKE, TIARI LOIS
Entity Type:Individual
Prefix:
First Name:TIARI
Middle Name:LOIS
Last Name:CLUKE
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 1:125 COUNTRY WALK
Mailing Address - Street 2:
Mailing Address - City:SOCIAL CIRCLE
Mailing Address - State:GA
Mailing Address - Zip Code:30025-5103
Mailing Address - Country:US
Mailing Address - Phone:708-315-9321
Mailing Address - Fax:
Practice Address - Street 1:125 COUNTRY WALK
Practice Address - Street 2:
Practice Address - City:SOCIAL CIRCLE
Practice Address - State:GA
Practice Address - Zip Code:30025-5103
Practice Address - Country:US
Practice Address - Phone:708-315-9321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician