Provider Demographics
NPI:1356884357
Name:GILLIARD, TIFFANY LEIGH (RIC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LEIGH
Last Name:GILLIARD
Suffix:
Gender:F
Credentials:RIC
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:LEIGH
Other - Last Name:GEARHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15536 GUINN LN
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-4639
Mailing Address - Country:US
Mailing Address - Phone:540-755-0350
Mailing Address - Fax:540-755-0351
Practice Address - Street 1:15536 GUINN LN
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-4639
Practice Address - Country:US
Practice Address - Phone:540-755-0350
Practice Address - Fax:540-755-0351
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-22
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247000000X
VA0704011433101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information