Provider Demographics
NPI:1245806348
Name:LINDSEY, TIFFANIE ROSE
Entity Type:Individual
Prefix:
First Name:TIFFANIE
Middle Name:ROSE
Last Name:LINDSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIFFANIE
Other - Middle Name:ROSE
Other - Last Name:BARANOVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 S REYNOLDS ST APT 617
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-3175
Mailing Address - Country:US
Mailing Address - Phone:573-837-2159
Mailing Address - Fax:
Practice Address - Street 1:1651 OLD MEADOW RD
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-4311
Practice Address - Country:US
Practice Address - Phone:703-564-1639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-28
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician