Provider Demographics
NPI:1851156806
Name:KIRKPATRICK, TIFFANY RENAE (LPC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:RENAE
Last Name:KIRKPATRICK
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 1:6003 VETERANS PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-6284
Mailing Address - Country:US
Mailing Address - Phone:706-223-1933
Mailing Address - Fax:706-223-1934
Practice Address - Street 1:5700 VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-9093
Practice Address - Country:US
Practice Address - Phone:706-221-3222
Practice Address - Fax:706-221-3282
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC014047101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional