Provider Demographics
NPI:1841839412
Name:CLIFFORD, TARA VIRGINIA (MA, LPC, LCADC, CCS)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:VIRGINIA
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:MA, LPC, LCADC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 CHAMPLAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08757-2533
Mailing Address - Country:US
Mailing Address - Phone:484-432-8371
Mailing Address - Fax:
Practice Address - Street 1:250 WASHINGTON ST STE A10
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-7575
Practice Address - Country:US
Practice Address - Phone:732-703-7387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00333800101YA0400X
NJ37PC00963400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)