Healthcare Provider Details

I. General information

NPI: 1790916609
Provider Name (Legal Business Name): TIQUICHA MONIQUE HARRIS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2009
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 THE EXCHANGE SE SUITE 420
ATLANTA GA
30339-2022
US

IV. Provider business mailing address

1425 MARKET BLVD STE 530-145
ROSWELL GA
30076-6708
US

V. Phone/Fax

Practice location:
  • Phone: 678-460-0345
  • Fax: 678-460-0350
Mailing address:
  • Phone: 678-852-2987
  • Fax: 888-375-4037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMSW004830
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: