Provider Demographics
NPI:1912585084
Name:TOUSSAINT, TIFFANY (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:
Last Name:TOUSSAINT
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16000 CAROLINES CV APT 16-104A
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-3155
Mailing Address - Country:US
Mailing Address - Phone:386-215-2002
Mailing Address - Fax:
Practice Address - Street 1:756 ELKCAM BLVD STE F
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-2646
Practice Address - Country:US
Practice Address - Phone:386-400-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW172401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW17240OtherLICENSE NUMBER