Healthcare Provider Details

I. General information

NPI: 1558743542
Provider Name (Legal Business Name): TIARRA CHARELLE MORRIS LCMHC, LCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 06/21/2023
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3209 ALLERTON CIRCLE E
GREENSBORO NC
27409
US

IV. Provider business mailing address

PO BOX 2420
KERNERSVILLE NC
27285-2420
US

V. Phone/Fax

Practice location:
  • Phone: 743-201-5834
  • Fax:
Mailing address:
  • Phone: 743-201-5834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number21911
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11705
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: