Provider Demographics
NPI:1861196669
Name:ELEY, TIA MARIE
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:MARIE
Last Name:ELEY
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 1:2341 WEATHERSTONE CIR SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-2085
Mailing Address - Country:US
Mailing Address - Phone:504-702-9974
Mailing Address - Fax:
Practice Address - Street 1:2341 WEATHERSTONE CIR SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-2085
Practice Address - Country:US
Practice Address - Phone:504-702-9974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician