Provider Demographics
NPI:1467112995
Name:ADAMS, TIFFANI LAKESHIA
Entity Type:Individual
Prefix:
First Name:TIFFANI
Middle Name:LAKESHIA
Last Name:ADAMS
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 1:3929 AIRPORT BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-1987
Mailing Address - Country:US
Mailing Address - Phone:251-414-3599
Mailing Address - Fax:251-217-4624
Practice Address - Street 1:3929 AIRPORT BLVD STE 310
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-1987
Practice Address - Country:US
Practice Address - Phone:251-414-3599
Practice Address - Fax:251-217-4624
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-24
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC2578A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC2578AOtherALC LICENSE