Provider Demographics
NPI:1043479041
Name:DUCKWORTH-MATTHEWS, TIFFANY ANN (MED)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:ANN
Last Name:DUCKWORTH-MATTHEWS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 WHITNEY AVENUE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056
Mailing Address - Country:US
Mailing Address - Phone:504-722-8267
Mailing Address - Fax:504-345-2035
Practice Address - Street 1:401 WHITNEY AVE STE 306
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-2502
Practice Address - Country:US
Practice Address - Phone:504-722-8267
Practice Address - Fax:504-345-2035
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2809101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional