Provider Demographics
NPI:1467154013
Name:MARTIN, TIFFANY LYNN (LISW-CP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LYNN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2153 E MAIN ST. STE. C, 14 #385
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:SC
Mailing Address - Zip Code:29334-9296
Mailing Address - Country:US
Mailing Address - Phone:864-384-9876
Mailing Address - Fax:
Practice Address - Street 1:3020 REIDVILLE RD STE B
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-5641
Practice Address - Country:US
Practice Address - Phone:864-308-8650
Practice Address - Fax:864-308-8647
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical