Healthcare Provider Details

I. General information

NPI: 1023949765
Provider Name (Legal Business Name): TIFFANY MCCLENDON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1862 AUBURN RD STE 118
DACULA GA
30019-1618
US

IV. Provider business mailing address

1862 AUBURN RD
DACULA GA
30019-1676
US

V. Phone/Fax

Practice location:
  • Phone: 404-919-4144
  • Fax:
Mailing address:
  • Phone: 404-919-4144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: