Provider Demographics
NPI:1518659978
Name:POLYCHRONES, TIFFANY ALEXANDRA (LPC RESIDENT)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ALEXANDRA
Last Name:POLYCHRONES
Suffix:
Gender:F
Credentials:LPC RESIDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 CABELL AVE APT J
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-2036
Mailing Address - Country:US
Mailing Address - Phone:434-448-4044
Mailing Address - Fax:
Practice Address - Street 1:818 CABELL AVE APT J
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-2036
Practice Address - Country:US
Practice Address - Phone:434-448-4044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704015744101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor