Provider Demographics
NPI:1104485911
Name:MYERS, TIA LUANA (LCPC)
Entity type:Individual
Prefix:MRS
First Name:TIA
Middle Name:LUANA
Last Name:MYERS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 BAYTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-3534
Mailing Address - Country:US
Mailing Address - Phone:410-231-8293
Mailing Address - Fax:
Practice Address - Street 1:2004 BAYTHORNE RD
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3534
Practice Address - Country:US
Practice Address - Phone:410-231-8293
Practice Address - Fax:443-342-0553
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC12625101YP2500X
MDLGP9486101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional