Healthcare Provider Details

I. General information

NPI: 1376289892
Provider Name (Legal Business Name): TIFFANY MARIE HOLLIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2022
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24077 COUNTRY LIVING RD STE 2
MILLSBORO DE
19966-3188
US

IV. Provider business mailing address

24077 COUNTRY LIVING RD STE 2
MILLSBORO DE
19966-3188
US

V. Phone/Fax

Practice location:
  • Phone: 302-772-5132
  • Fax:
Mailing address:
  • Phone: 302-224-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC-0011782
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: