Provider Demographics
NPI:1356089791
Name:EDWARDS, TIFFANY TAYLOR
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:TAYLOR
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 N RIDGE DR APT C
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-2154
Mailing Address - Country:US
Mailing Address - Phone:828-712-2462
Mailing Address - Fax:
Practice Address - Street 1:128 N RIDGE DR APT C
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-2154
Practice Address - Country:US
Practice Address - Phone:828-712-2462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15506101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health