Provider Demographics
NPI:1407548738
Name:REAVES, TIFFANY JOANN (LICSW)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:JOANN
Last Name:REAVES
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17256 FERRY RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-7013
Mailing Address - Country:US
Mailing Address - Phone:256-777-9114
Mailing Address - Fax:
Practice Address - Street 1:17256 FERRY RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-7013
Practice Address - Country:US
Practice Address - Phone:256-777-9114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5361C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical