Provider Demographics
NPI:1548805922
Name:SWAN, TIFFINIE ANTWANETTE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:TIFFINIE
Middle Name:ANTWANETTE
Last Name:SWAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 S STATE ROAD 7 APT 303
Mailing Address - Street 2:
Mailing Address - City:NORTH LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-4650
Mailing Address - Country:US
Mailing Address - Phone:954-817-4325
Mailing Address - Fax:
Practice Address - Street 1:5400 S UNIVERSITY DR STE 504
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-5313
Practice Address - Country:US
Practice Address - Phone:954-817-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-09
Last Update Date:2019-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3658106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist