Healthcare Provider Details

I. General information

NPI: 1689291197
Provider Name (Legal Business Name): TIFFANY URBY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2020
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2670 CRAIN HIGHWAY SUITE 501
WALDORF MD
20601
US

IV. Provider business mailing address

312 ZELMA AVE
CAPITOL HEIGHTS MD
20743-3123
US

V. Phone/Fax

Practice location:
  • Phone: 301-818-0860
  • Fax:
Mailing address:
  • Phone: 301-385-8401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP10536
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC12759
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: