Provider Demographics
NPI:1821732074
Name:DORAN, TIFFANY ANNE
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANNE
Last Name:DORAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1473 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43211-1428
Mailing Address - Country:US
Mailing Address - Phone:843-263-0206
Mailing Address - Fax:
Practice Address - Street 1:6161 BUSCH BLVD STE 290
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-2587
Practice Address - Country:US
Practice Address - Phone:614-987-5003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-25
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.187079101YA0400X
OHAPS.003156175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty