Provider Demographics
NPI:1134091861
Name:TOLLIVER, TAMARA
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:TOLLIVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10095 WASHINGTON BLVD N APT 106
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1950
Mailing Address - Country:US
Mailing Address - Phone:347-557-4356
Mailing Address - Fax:
Practice Address - Street 1:9701 PHILADELPHIA CT
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4400
Practice Address - Country:US
Practice Address - Phone:301-210-4860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD334371041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool