Provider Demographics
NPI:1497950547
Name:MILAM, TIFFANY H
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:H
Last Name:MILAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:MORMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:500 W 10TH STREET
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801
Mailing Address - Country:US
Mailing Address - Phone:302-652-6776
Mailing Address - Fax:302-652-5150
Practice Address - Street 1:500 W 10TH STREET
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801
Practice Address - Country:US
Practice Address - Phone:302-652-6776
Practice Address - Fax:302-652-5150
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE617330Medicare PIN