Provider Demographics
NPI:1235377227
Name:COLEMAN, TIFFINI (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TIFFINI
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:984 BLACKBERRY LN
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-7492
Mailing Address - Country:US
Mailing Address - Phone:310-413-0768
Mailing Address - Fax:
Practice Address - Street 1:11519 CARLISLE PL
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-7233
Practice Address - Country:US
Practice Address - Phone:909-948-2898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-28
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW701131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical