Provider Demographics
NPI:1043775810
Name:FRYAR, TIFFANI VENIGEE (LPC)
Entity Type:Individual
Prefix:MS
First Name:TIFFANI
Middle Name:VENIGEE
Last Name:FRYAR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 NEW CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:WHITESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30185-2803
Mailing Address - Country:US
Mailing Address - Phone:678-890-6127
Mailing Address - Fax:
Practice Address - Street 1:206 BANKHEAD HWY
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3455
Practice Address - Country:US
Practice Address - Phone:678-890-6127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-06
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005204101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional