Provider Demographics
NPI:1124699392
Name:GEDDIE, JAMIA MICHAELA TAZZIA (LCSWA)
Entity type:Individual
Prefix:
First Name:JAMIA
Middle Name:MICHAELA TAZZIA
Last Name:GEDDIE
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 LOCKHART ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-4001
Mailing Address - Country:US
Mailing Address - Phone:704-698-7934
Mailing Address - Fax:
Practice Address - Street 1:1301 LOCKHART ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-4001
Practice Address - Country:US
Practice Address - Phone:704-698-7934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0164941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical