Healthcare Provider Details

I. General information

NPI: 1790691558
Provider Name (Legal Business Name): TIARA C HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 LORD BALTIMORE DR STE 110
WINDSOR MILL MD
21244-5804
US

IV. Provider business mailing address

3344 DOLFIELD AVE
BALTIMORE MD
21215-7238
US

V. Phone/Fax

Practice location:
  • Phone: 410-844-0770
  • Fax:
Mailing address:
  • Phone: 843-696-5348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP18381
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: