Provider Demographics
NPI:1982391074
Name:CHAMBLIN, TIFFANI NICOLE
Entity Type:Individual
Prefix:MRS
First Name:TIFFANI
Middle Name:NICOLE
Last Name:CHAMBLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 HOT SPRINGS WAY
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-7752
Mailing Address - Country:US
Mailing Address - Phone:804-490-1098
Mailing Address - Fax:
Practice Address - Street 1:19 HOT SPRINGS WAY
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-7752
Practice Address - Country:US
Practice Address - Phone:804-490-1098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0906010257104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker