Provider Demographics
NPI:1679325344
Name:VALENTINE, TIFFANY LATISSHA (MA, LLPC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LATISSHA
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 WOODBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1622
Mailing Address - Country:US
Mailing Address - Phone:313-815-5955
Mailing Address - Fax:
Practice Address - Street 1:17515 W 9 MILE RD STE 755
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4422
Practice Address - Country:US
Practice Address - Phone:586-229-1595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451023295101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health