Provider Demographics
NPI:1124541875
Name:DUCK, TIFFANY CHANELL (PHD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:CHANELL
Last Name:DUCK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 BRACEY CIR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:VA
Mailing Address - Zip Code:23487-6117
Mailing Address - Country:US
Mailing Address - Phone:757-371-5495
Mailing Address - Fax:
Practice Address - Street 1:11339 WINDSOR BLVD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:VA
Practice Address - Zip Code:23487-5657
Practice Address - Country:US
Practice Address - Phone:757-371-5495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-24
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor