Healthcare Provider Details

I. General information

NPI: 1700347630
Provider Name (Legal Business Name): TIFFANY NICOLE ABDULLAH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5014 MONUMENT AVE
RICHMOND VA
23230-3620
US

IV. Provider business mailing address

4501 AVIA CIR APT 407
HENRICO VA
23233-7835
US

V. Phone/Fax

Practice location:
  • Phone: 804-497-4676
  • Fax: 804-497-4677
Mailing address:
  • Phone: 804-683-8172
  • Fax: 804-497-4677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701007990
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: