Healthcare Provider Details

I. General information

NPI: 1215458542
Provider Name (Legal Business Name): TIERRA COLLINS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 06/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5540 FALMOUTH ST STE 201
RICHMOND VA
23230-1800
US

IV. Provider business mailing address

5530 PRINCESS ELLA LN
RICHMOND VA
23225-7373
US

V. Phone/Fax

Practice location:
  • Phone: 804-497-4676
  • Fax: 804-497-4677
Mailing address:
  • Phone: 804-397-3507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904009967
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: