Provider Demographics
NPI:1386819035
Name:WHITTINGTON, TIFFANY C (LPC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:C
Last Name:WHITTINGTON
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 1:3855 SHALLOWFORD RD
Mailing Address - Street 2:SUITE 420
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-4195
Mailing Address - Country:US
Mailing Address - Phone:678-908-5820
Mailing Address - Fax:678-908-5820
Practice Address - Street 1:3855 SHALLOWFORD RD
Practice Address - Street 2:SUITE 420
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-4195
Practice Address - Country:US
Practice Address - Phone:678-908-5820
Practice Address - Fax:678-908-5820
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003420101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA816992167AMedicaid