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General NPI Number Information
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NPI Number | 1437509577
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Entity Type | Individual
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Provider Name | TIFFANY MARIE HENDERSON MSW, LGSW
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Gender | Female
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Dates
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Enumeration Date | 06/20/2016
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Last Update Date | 03/29/2025
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Provider Practice Location Address
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Address Line | 1100 MAIN ST STE 104
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City | WHEELING
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State | WV
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Zip | 26003-2737
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Country | US
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Telephone | 304-460-5123
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Fax |
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Provider Business Mailing Address
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Address Line | 111 PARK VIEW LN STE 204
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City | WHEELING
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State | WV
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Zip | 26003-5406
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Country | US
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Telephone | 304-243-1865
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | BP00945014
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License Number State | WV
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