Provider Demographics
NPI:1225567290
Name:GILL, TIFFANY AMANDA (LCSW, LCADC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:AMANDA
Last Name:GILL
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:577 CROMWELL WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-4255
Mailing Address - Country:US
Mailing Address - Phone:859-433-0762
Mailing Address - Fax:859-681-6214
Practice Address - Street 1:501 DARBY CREEK RD STE 56D
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2610
Practice Address - Country:US
Practice Address - Phone:859-433-0762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY167163101YA0400X
KY2532271041C0700X, 1041C0700X
KY73961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100552960Medicaid