Provider Demographics
NPI:1578908166
Name:ANDERSON, TIFFANY SIOBHAN (PSYD, BCBA)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:SIOBHAN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PSYD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 LENOX RD NE STE 750
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1353
Mailing Address - Country:US
Mailing Address - Phone:470-682-3536
Mailing Address - Fax:470-682-3646
Practice Address - Street 1:3355 LENOX RD NE STE 750
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1353
Practice Address - Country:US
Practice Address - Phone:404-383-0799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY004716101YM0800X, 103TC0700X
1-20-46254103K00000X
103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical