Provider Demographics
NPI:1679236186
Name:SMITH, TIFFANI - RAE ANN (LPC)
Entity Type:Individual
Prefix:
First Name:TIFFANI - RAE
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WILTON PASTURE LN APT 302
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-7624
Mailing Address - Country:US
Mailing Address - Phone:434-218-0561
Mailing Address - Fax:
Practice Address - Street 1:100 WILTON PASTURE LN APT 302
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-7624
Practice Address - Country:US
Practice Address - Phone:434-218-0561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0701013362101YM0800X
VA0704013755101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health