Healthcare Provider Details

I. General information

NPI: 1922722784
Provider Name (Legal Business Name): MS. TIFFANY NICOLE ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 LEE ST E STE 201
CHARLESTON WV
25301-1707
US

IV. Provider business mailing address

1219 THOMAS RD
SOUTH CHARLESTON WV
25303-2926
US

V. Phone/Fax

Practice location:
  • Phone: 304-807-6227
  • Fax:
Mailing address:
  • Phone: 304-444-2921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: