Provider Demographics
NPI:1790240778
Name:KIDD, TYFFANY LOUISE (LGPC)
Entity Type:Individual
Prefix:MS
First Name:TYFFANY
Middle Name:LOUISE
Last Name:KIDD
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 CONNECTICUT AVE NW APT 417
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-6021
Mailing Address - Country:US
Mailing Address - Phone:202-335-3487
Mailing Address - Fax:202-333-1367
Practice Address - Street 1:4545 CONNECTICUT AVE NW APT 417
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-6021
Practice Address - Country:US
Practice Address - Phone:202-335-3487
Practice Address - Fax:202-333-1367
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLGPC00354101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health