Provider Demographics
NPI:1194061770
Name:WARREN, TIA L (LCSW)
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:L
Last Name:WARREN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TIA
Other - Middle Name:L
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4566 LAWRENCEVILLE HWY NW STE 101
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-3686
Mailing Address - Country:US
Mailing Address - Phone:770-217-7563
Mailing Address - Fax:
Practice Address - Street 1:4566 LAWRENCEVILLE HWY NW STE 101
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3686
Practice Address - Country:US
Practice Address - Phone:770-217-7563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0047911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical