Provider Demographics
NPI:1871177857
Name:HENRY, TIA (SOCIAL WORK STUDENT)
Entity type:Individual
Prefix:MRS
First Name:TIA
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:SOCIAL WORK STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2044 DYREHAVEN CT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317
Mailing Address - Country:US
Mailing Address - Phone:850-228-8424
Mailing Address - Fax:
Practice Address - Street 1:1375-A CROSS CREEK CIRCLE
Practice Address - Street 2:
Practice Address - City:TALLAHASSSEE
Practice Address - State:FL
Practice Address - Zip Code:32301
Practice Address - Country:US
Practice Address - Phone:850-405-3639
Practice Address - Fax:949-561-4494
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program