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General NPI Number Information
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NPI Number | 1194120857
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Entity Type | Individual
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Provider Name | TIFFANY CHERIE GOSSETT LPC
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Gender | Female
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Dates
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Enumeration Date | 10/23/2014
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Last Update Date | 10/23/2014
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Provider Practice Location Address
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Address Line | 2712 PARKWOOD DR
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City | BRUNSWICK
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State | GA
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Zip | 31520-4727
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Country | US
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Telephone | 912-265-7382
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Fax |
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Provider Business Mailing Address
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Address Line | 251 RAINBOW LN
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City | WOODBINE
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State | GA
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Zip | 31569-4053
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Country | US
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Telephone | 706-951-3801
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 008082
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License Number State | GA
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