Provider Demographics
NPI:1780257667
Name:BRASS, TIA MARIE (PBSF)
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:MARIE
Last Name:BRASS
Suffix:
Gender:F
Credentials:PBSF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 29TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23607-4202
Mailing Address - Country:US
Mailing Address - Phone:443-752-2826
Mailing Address - Fax:
Practice Address - Street 1:1044 29TH ST
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23607-4202
Practice Address - Country:US
Practice Address - Phone:443-752-2826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst