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General NPI Number Information
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NPI Number | 1861037616
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Entity Type | Individual
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Provider Name | TIFFANY LARAY DENNIS LPC, MS
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Gender | Female
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Dates
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Enumeration Date | 11/14/2019
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Last Update Date | 11/15/2022
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Provider Practice Location Address
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Address Line | 5887 GLENRIDGE DR STE 230
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City | ATLANTA
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State | GA
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Zip | 30328-9929
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Country | US
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Telephone | 770-410-8107
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Fax |
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Provider Business Mailing Address
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Address Line | 550 NORTHRIDGE PKWY APT 1411
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City | SANDY SPRINGS
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State | GA
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Zip | 30350-3401
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Country | US
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Telephone | 803-840-3763
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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 | LPC013304
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License Number State | GA
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