Provider Demographics
NPI:1801226147
Name:MILBOURNE-JAMES, TIFFANY (LCSW, CPC)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:
Last Name:MILBOURNE-JAMES
Suffix:
Gender:F
Credentials:LCSW, CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 GREYTHORNE DR
Mailing Address - Street 2:
Mailing Address - City:KATHLEEN
Mailing Address - State:GA
Mailing Address - Zip Code:31047-2899
Mailing Address - Country:US
Mailing Address - Phone:478-365-0847
Mailing Address - Fax:
Practice Address - Street 1:304 GREYTHORNE DR
Practice Address - Street 2:
Practice Address - City:KATHLEEN
Practice Address - State:GA
Practice Address - Zip Code:31047-2899
Practice Address - Country:US
Practice Address - Phone:478-365-0847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-23
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0066271041C0700X
GA16276225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist