Healthcare Provider Details

I. General information

NPI: 1457272783
Provider Name (Legal Business Name): TIA STEPHENS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1882 CAPITAL CIR NE
TALLAHASSEE FL
32308-4530
US

IV. Provider business mailing address

306 BELMONT RD
TALLAHASSEE FL
32301-2708
US

V. Phone/Fax

Practice location:
  • Phone: 850-296-8214
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW26833
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: