Provider Demographics
NPI:1801403365
Name:BUCHANAN, TIFFANY (LPC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:BUCHANAN
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:PO BOX 90
Mailing Address - Street 2:
Mailing Address - City:COEBURN
Mailing Address - State:VA
Mailing Address - Zip Code:24230-0090
Mailing Address - Country:US
Mailing Address - Phone:276-455-5556
Mailing Address - Fax:
Practice Address - Street 1:5626 PATRIOT DR
Practice Address - Street 2:
Practice Address - City:WISE
Practice Address - State:VA
Practice Address - Zip Code:24293-1138
Practice Address - Country:US
Practice Address - Phone:276-455-5556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2021-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008830101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional