Provider Demographics
NPI:1932510328
Name:HEBRON, TIFFANY JOY (MA, LMHC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY JOY
Middle Name:
Last Name:HEBRON
Suffix:
Gender:F
Credentials:MA, LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15000 MIDLANTIC DR STE 110
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-1573
Mailing Address - Country:US
Mailing Address - Phone:856-380-2763
Mailing Address - Fax:
Practice Address - Street 1:15000 MIDLANTIC DR STE 110
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1573
Practice Address - Country:US
Practice Address - Phone:856-380-2763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-19
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007052101YM0800X
NJ37PC00610900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health