Provider Demographics
NPI:1316612690
Name:ROBERTS, TIANA (MSW, LCSW-A)
Entity type:Individual
Prefix:
First Name:TIANA
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MSW, LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 COX RD STE C8
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-0607
Mailing Address - Country:US
Mailing Address - Phone:704-884-1424
Mailing Address - Fax:
Practice Address - Street 1:543 COX RD STE D1
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-0616
Practice Address - Country:US
Practice Address - Phone:704-898-2618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty