Provider Demographics
NPI:1568033074
Name:REESE, TIFFANY CRYSTAL (MS, LPCA)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:CRYSTAL
Last Name:REESE
Suffix:
Gender:F
Credentials:MS, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 BELLE ISLE AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-8379
Mailing Address - Country:US
Mailing Address - Phone:843-284-6423
Mailing Address - Fax:
Practice Address - Street 1:1501 BELLE ISLE AVE STE 110
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-8379
Practice Address - Country:US
Practice Address - Phone:843-284-6423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2204548101YP2500X
SC8347101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional