Healthcare Provider Details

I. General information

NPI: 1366395436
Provider Name (Legal Business Name): TIA TARVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 LONG ST
HURTSBORO AL
36860
US

IV. Provider business mailing address

PO BOX 672
HURTSBORO AL
36860-0672
US

V. Phone/Fax

Practice location:
  • Phone: 334-740-1606
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberCSW04475
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number150119294
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: