Provider Demographics
NPI:1649841958
Name:STEPHENS, TIFFANY RENEE (DSW, LCSW)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:RENEE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:DSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 HONEY TREE LN
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-4683
Mailing Address - Country:US
Mailing Address - Phone:434-429-2201
Mailing Address - Fax:
Practice Address - Street 1:2097 LANGHORNE RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1443
Practice Address - Country:US
Practice Address - Phone:434-200-3204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040130581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical