Provider Demographics
NPI:1710504923
Name:YOUNGER BANKS, TIFFANY
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:
Last Name:YOUNGER BANKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 NATIONAL PLZ STE 300
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-1153
Mailing Address - Country:US
Mailing Address - Phone:301-257-0585
Mailing Address - Fax:
Practice Address - Street 1:137 NATIONAL PLZ STE 300
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-1153
Practice Address - Country:US
Practice Address - Phone:301-257-0585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP10380101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional