Provider Demographics
NPI:1942900915
Name:BALKCOM, TIFFANY HOWARD (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:HOWARD
Last Name:BALKCOM
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 DOVE PL
Mailing Address - Street 2:
Mailing Address - City:SOCIAL CIRCLE
Mailing Address - State:GA
Mailing Address - Zip Code:30025-3068
Mailing Address - Country:US
Mailing Address - Phone:404-944-8472
Mailing Address - Fax:
Practice Address - Street 1:261 DOVE PL
Practice Address - Street 2:
Practice Address - City:SOCIAL CIRCLE
Practice Address - State:GA
Practice Address - Zip Code:30025-3068
Practice Address - Country:US
Practice Address - Phone:140-499-4847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-07
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-2368049103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst