Provider Demographics
NPI:1487050126
Name:WATFORD, TIARA (LCSW)
Entity type:Individual
Prefix:
First Name:TIARA
Middle Name:
Last Name:WATFORD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 MOORE TOWN RD S
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-9770
Mailing Address - Country:US
Mailing Address - Phone:252-455-8710
Mailing Address - Fax:
Practice Address - Street 1:211 NORTH ST W
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-3036
Practice Address - Country:US
Practice Address - Phone:252-455-8710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-07
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0090081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical