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General NPI Number Information
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NPI Number | 1376275602
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Entity Type | Individual
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Provider Name | TIERRA L COPELAND
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Gender | Female
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Dates
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Enumeration Date | 06/27/2022
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Last Update Date | 06/27/2022
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Provider Practice Location Address
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Address Line | 10640 PAGE AVE STE 230
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City | FAIRFAX
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State | VA
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Zip | 22030-4012
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Country | US
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Telephone | 304-350-9349
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Fax |
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Provider Business Mailing Address
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Address Line | 4820 RIVER VALLEY WAY
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City | BOWIE
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State | MD
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Zip | 20720-3478
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Country | US
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Telephone | 304-350-9349
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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