Provider Demographics
NPI:1720357205
Name:PARKER, TIFFANY ADELE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:ADELE
Last Name:PARKER
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 1:5459 VININGS LAKE WAY SW
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-2558
Mailing Address - Country:US
Mailing Address - Phone:404-354-7616
Mailing Address - Fax:
Practice Address - Street 1:5459 VININGS LAKE WAY SW
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-2558
Practice Address - Country:US
Practice Address - Phone:404-354-7616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-29
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006730101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional