Provider Demographics
NPI:1891337549
Name:SMITHSON, TIFFANI (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANI
Middle Name:
Last Name:SMITHSON
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 KENTLANDS BLVD STE 5206
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-5446
Mailing Address - Country:US
Mailing Address - Phone:240-855-5428
Mailing Address - Fax:
Practice Address - Street 1:267 KENTLANDS BLVD # 5206
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-5446
Practice Address - Country:US
Practice Address - Phone:240-855-5428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC50081082104100000X, 1041C0700X
SC140631041C0700X
MD178081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0522OtherCOMMERCIAL