Healthcare Provider Details

I. General information

NPI: 1306787502
Provider Name (Legal Business Name): PHILIPA TIFANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 WINTER PARK CT
UPPER MARLBORO MD
20774-7550
US

IV. Provider business mailing address

3205 WINTER PARK CT
UPPER MARLBORO MD
20774-7550
US

V. Phone/Fax

Practice location:
  • Phone: 202-439-0038
  • Fax:
Mailing address:
  • Phone: 202-439-0038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: