Healthcare Provider Details

I. General information

NPI: 1023709029
Provider Name (Legal Business Name): TIFFANY NICOLE HUFF ADT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2023
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 MADISON PARK DR
GLEN BURNIE MD
21061-5881
US

IV. Provider business mailing address

18 JANWALL CT
ANNAPOLIS MD
21403-1916
US

V. Phone/Fax

Practice location:
  • Phone: 410-999-0891
  • Fax:
Mailing address:
  • Phone: 240-781-9930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: