Provider Demographics
NPI:1528820115
Name:GOWENS, TIARAH ANNESIA (MCMHC)
Entity type:Individual
Prefix:
First Name:TIARAH
Middle Name:ANNESIA
Last Name:GOWENS
Suffix:
Gender:F
Credentials:MCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4293 GROVE LAKE ST
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-8156
Mailing Address - Country:US
Mailing Address - Phone:678-577-3606
Mailing Address - Fax:
Practice Address - Street 1:4566 LAWRENCEVILLE HWY NW STE 101
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3686
Practice Address - Country:US
Practice Address - Phone:770-217-7563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health