Provider Demographics
NPI:1225702061
Name:GREEN, TIFFANY NOEL (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:NOEL
Last Name:GREEN
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CORPORATE DR STE 301
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-4889
Mailing Address - Country:US
Mailing Address - Phone:862-237-6791
Mailing Address - Fax:888-307-5343
Practice Address - Street 1:800 CORPORATE DR STE 301
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-4889
Practice Address - Country:US
Practice Address - Phone:862-237-6791
Practice Address - Fax:888-307-5343
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00396700101YM0800X
CAAPCC5972101YM0800X
VA0701011804101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health