Provider Demographics
NPI:1710682695
Name:GLOVER, TIFFANY (LPC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:GLOVER
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 1:103 JONESBORO RD
Mailing Address - Street 2:STE K
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-7376
Mailing Address - Country:US
Mailing Address - Phone:404-852-9311
Mailing Address - Fax:
Practice Address - Street 1:255 CORPORATE CENTER DR STE C
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7376
Practice Address - Country:US
Practice Address - Phone:404-852-9311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-31
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
GALPC013650101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional