Provider Demographics
NPI:1376350389
Name:WATKINS, TIARA BELL
Entity type:Individual
Prefix:
First Name:TIARA
Middle Name:BELL
Last Name:WATKINS
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 1:19225 WOODBINE ST APT 31
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-4656
Mailing Address - Country:US
Mailing Address - Phone:810-830-2950
Mailing Address - Fax:
Practice Address - Street 1:27085 GRATIOT AVE STE 101
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-2984
Practice Address - Country:US
Practice Address - Phone:586-204-5560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical