Healthcare Provider Details

I. General information

NPI: 1235085085
Provider Name (Legal Business Name): TIA PRESTON ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 DOWNEY AVE
MODESTO CA
95354-1208
US

IV. Provider business mailing address

121 DOWNEY AVE 121 DOWNEY AVE
MODESTO CA
95354-1208
US

V. Phone/Fax

Practice location:
  • Phone: 209-417-0219
  • Fax:
Mailing address:
  • Phone: 209-417-0219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW128290
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: