Provider Demographics
NPI:1336697416
Name:REDDICK, TIFFANY (LPC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:REDDICK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3812 REECE FARMS CT
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-1682
Mailing Address - Country:US
Mailing Address - Phone:770-875-7892
Mailing Address - Fax:
Practice Address - Street 1:3812 REECE FARMS CT
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-1682
Practice Address - Country:US
Practice Address - Phone:770-875-7892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009205101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional