Provider Demographics
NPI:1104280932
Name:WILLIAMS, TIFFANY DENISE (THERAPIST)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:DENISE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:THERAPIST
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:DENISE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:THERAPIST
Mailing Address - Street 1:8939 S SEPULVEDA BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3605
Mailing Address - Country:US
Mailing Address - Phone:323-826-7359
Mailing Address - Fax:323-826-5262
Practice Address - Street 1:8939 S SEPULVEDA BLVD STE 102
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3605
Practice Address - Country:US
Practice Address - Phone:323-826-7359
Practice Address - Fax:323-826-5262
Is Sole Proprietor?:No
Enumeration Date:2016-04-07
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8288101YM0800X, 1041C0700X, 101YP2500X
CA3529101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical