Provider Information for 1104485911
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Mrs. TIA LUANA MYERS LCPC
Sex: Female
NPI: 1104485911
Last Updated: 2022-05-05
Certification Date: 2022-05-05
Certification Date: 2022-05-05
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1104485911 | ||||||||||||
| Enumeration Date | 2019-06-06 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 2004 BAYTHORNE RD PRINCE FREDERICK, MD 20678-3534 United States Phone: 410-231-8293 | Fax: | ||||||||||||
| Primary Practice Address | 2004 BAYTHORNE RD PRINCE FREDERICK, MD 20678-3534 United States Phone: 410-231-8293 | Fax:443-342-0553 | ||||||||||||
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