Provider Demographics
NPI:1932689171
Name:BLAIR, TIFFANY (LCSW-C)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:BLAIR
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:PO BOX 172
Mailing Address - Street 2:
Mailing Address - City:LUSBY
Mailing Address - State:MD
Mailing Address - Zip Code:20657-0172
Mailing Address - Country:US
Mailing Address - Phone:443-214-3625
Mailing Address - Fax:
Practice Address - Street 1:6188 OXON HILL RD STE 500
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3136
Practice Address - Country:US
Practice Address - Phone:301-567-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21415104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker