MEDICARE: TIERRA MONIQUE PARRIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	23215	MD
2	1041C0700X	Clinical Social Worker	0904017974	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326685819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIERRA MONIQUE PARRIS

Provider Business Mailing Address
First Line	:	121 MAINSAIL LOOP
Second Line	:
City	:	YORKTOWN
State	:	VA
Zip	:	23693-5602
Country	:	US
Telephone Number	:	757-300-4475
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 MAINSAIL LOOP
Second Line	:
City	:	YORKTOWN
State	:	VA
Zip	:	23693-5602
Country	:	US
Telephone Number	:	571-676-9529
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2019
Last Update Date	:	05/26/2025

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