Provider Demographics
NPI:1841923232
Name:GLYMPH, TIERRA S (LCSW)
Entity type:Individual
Prefix:
First Name:TIERRA
Middle Name:S
Last Name:GLYMPH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5022 AMES ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-5309
Mailing Address - Country:US
Mailing Address - Phone:202-823-2745
Mailing Address - Fax:
Practice Address - Street 1:228 S WASHINGTON ST STE 310
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-5404
Practice Address - Country:US
Practice Address - Phone:703-935-0058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA090401301041C0700X
VA09040139771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical