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General NPI Number Information
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NPI Number | 1811493497
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Entity Type | Individual
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Provider Name | TIFFANY JONES
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Gender | Female
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Dates
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Enumeration Date | 04/03/2018
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Last Update Date | 04/03/2018
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Provider Practice Location Address
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Address Line | 922 COURT ST NE OFC 103
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City | CONYERS
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State | GA
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Zip | 30012-4540
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Country | US
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Telephone | 770-278-7777
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Fax |
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Provider Business Mailing Address
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Address Line | 117 NORTHERN AVE APT 6
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City | DECATUR
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State | GA
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Zip | 30030-2406
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Country | US
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Telephone | 407-361-4671
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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 | LPC008138
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License Number State | GA
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