| NPI | 1639614019 |
|---|---|
| Former Name | TIARA WYNN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WV 2229) |
| Enumeration Date | 2016-12-21 |
| Last Update Date | 2026-02-16 |