Provider Demographics
NPI:1932675386
Name:TIFFANI DILWORTH LLC
Entity Type:Organization
Organization Name:TIFFANI DILWORTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANI
Authorized Official - Middle Name:
Authorized Official - Last Name:DILWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-824-1340
Mailing Address - Street 1:110 UNIVERSITY BLVD W UNIT 3651
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20918-0050
Mailing Address - Country:US
Mailing Address - Phone:405-824-1340
Mailing Address - Fax:
Practice Address - Street 1:110 UNIVERSITY BLVD W UNIT 3651
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20918-0050
Practice Address - Country:US
Practice Address - Phone:443-274-7917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health