Healthcare Provider Details

I. General information

NPI: 1730362989
Provider Name (Legal Business Name): TIFFANY N JESTER NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIFFANY N TOMASKI

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 MONT BLANC BLVD
DOVER DE
19904-7615
US

IV. Provider business mailing address

103 MONT BLANC BLVD
DOVER DE
19904-7615
US

V. Phone/Fax

Practice location:
  • Phone: 302-678-3020
  • Fax:
Mailing address:
  • Phone: 302-678-3020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0000596
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: