MEDICARE: MISS TIFFANY M. LEE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C006259	NC

General Provider Information

NPI Number	:	1750520326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS TIFFANY M. LEE LCSW

Provider Business Mailing Address
First Line	:	6310 LONG LEAF CT
Second Line	:	APT. 3D
City	:	HIGH POINT
State	:	NC
Zip	:	27265-6009
Country	:	US
Telephone Number	:	336-882-5253
Fax Number	:

Provider Business Practice Location Address
First Line	:	6310 LONG LEAF CT
Second Line	:	APT. 3D
City	:	HIGH POINT
State	:	NC
Zip	:	27265-6009
Country	:	US
Telephone Number	:	336-882-5253
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2009
Last Update Date	:	02/05/2009

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