Provider Demographics
NPI:1184057945
Name:CARR, TIESHA MIA (EDD, LPC)
Entity type:Individual
Prefix:DR
First Name:TIESHA
Middle Name:MIA
Last Name:CARR
Suffix:
Gender:F
Credentials:EDD, LPC
Other - Prefix:DR
Other - First Name:T. MIA
Other - Middle Name:
Other - Last Name:CARR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDD, LPC
Mailing Address - Street 1:1293 N LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-2093
Mailing Address - Country:US
Mailing Address - Phone:443-850-1701
Mailing Address - Fax:
Practice Address - Street 1:1293 N LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-2093
Practice Address - Country:US
Practice Address - Phone:985-326-1882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2021-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007337101YP2500X
MDLC6047101YP2500X
LA7111101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional