Healthcare Provider Details

I. General information

NPI: 1376258111
Provider Name (Legal Business Name): TIFFANY GREEN THOMPSON LICSW-S, PIP, CDBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1239 HIGHWAY 77
ATTALLA AL
35954-7093
US

IV. Provider business mailing address

1239 HIGHWAY 77
ATTALLA AL
35954-7093
US

V. Phone/Fax

Practice location:
  • Phone: 256-907-1676
  • Fax: 256-467-8504
Mailing address:
  • Phone: 256-907-1676
  • Fax: 256-467-8504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5214C
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW128664
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: