Provider Demographics
NPI:1881009173
Name:MYERS, TIARRA M (MSW)
Entity type:Individual
Prefix:
First Name:TIARRA
Middle Name:M
Last Name:MYERS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3214 ELLINGFORD RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-2599
Mailing Address - Country:US
Mailing Address - Phone:803-236-2932
Mailing Address - Fax:
Practice Address - Street 1:3021 SENNA DR STE B
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-6727
Practice Address - Country:US
Practice Address - Phone:704-443-0144
Practice Address - Fax:704-476-1331
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
NCC0136641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst