Provider Demographics
NPI:1144839101
Name:RIVERS, TIERRA S
Entity type:Individual
Prefix:MRS
First Name:TIERRA
Middle Name:S
Last Name:RIVERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIERRA
Other - Middle Name:S
Other - Last Name:RIVERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CERTIFIED HAIR LOSS
Mailing Address - Street 1:2702 W SURREY DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-5513
Mailing Address - Country:US
Mailing Address - Phone:843-817-6803
Mailing Address - Fax:
Practice Address - Street 1:2702 W SURREY DR
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-5513
Practice Address - Country:US
Practice Address - Phone:843-817-6803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-27
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC764171744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management