Provider Demographics
NPI:1194478933
Name:REDDICK, TIARA ASHLEE (LPC)
Entity type:Individual
Prefix:
First Name:TIARA
Middle Name:ASHLEE
Last Name:REDDICK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9687 MAIN ST STE D
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-3753
Mailing Address - Country:US
Mailing Address - Phone:703-303-8832
Mailing Address - Fax:703-991-8317
Practice Address - Street 1:9687 MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-3753
Practice Address - Country:US
Practice Address - Phone:703-303-8832
Practice Address - Fax:703-991-8317
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2022-04-05
Deactivation Date:2022-02-01
Deactivation Code:
Reactivation Date:2022-04-05
Provider Licenses
StateLicense IDTaxonomies
VA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor