Healthcare Provider Details

I. General information

NPI: 1093167462
Provider Name (Legal Business Name): TIFFANY WILLIAMS LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2016
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1814 ST JOHN RD
BRAXTON MS
39044-9470
US

IV. Provider business mailing address

1814 ST JOHN RD
BRAXTON MS
39044-9470
US

V. Phone/Fax

Practice location:
  • Phone: 601-942-5382
  • Fax:
Mailing address:
  • Phone: 601-942-5382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC2607
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCPC7842
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCPC
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCPC7842
License Number StateID
# 5
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC2607
License Number StateMS
# 6
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLPC2607
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: