Provider Demographics
NPI:1083937288
Name:COLLINS, TIFFANY LAURICE (LPC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LAURICE
Last Name:COLLINS
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 1:1349 AYRAULT RD
Mailing Address - Street 2:#93
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-8942
Mailing Address - Country:US
Mailing Address - Phone:585-944-0937
Mailing Address - Fax:
Practice Address - Street 1:1349 AYRAULT RD
Practice Address - Street 2:#93
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-8942
Practice Address - Country:US
Practice Address - Phone:585-944-0937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2017-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14334101YP2500X
NY005460101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional