Healthcare Provider Details

I. General information

NPI: 1598615403
Provider Name (Legal Business Name): TIFFANY ANNE FANCHER LPC-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2026
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 COVEY CIR
FRANKLIN VA
23851-2900
US

IV. Provider business mailing address

149 COVEY CIR
FRANKLIN VA
23851-2900
US

V. Phone/Fax

Practice location:
  • Phone: 804-924-2236
  • Fax:
Mailing address:
  • Phone: 804-924-2236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704016765
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: