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General NPI Number Information
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NPI Number | 1871808550
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Entity Type | Organization
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Legal Business Name | TIFT & TIFT LLC
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Dates
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Enumeration Date | 08/18/2010
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Last Update Date | 08/18/2010
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Provider Practice Location Address
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Address Line | 36 COATES RD
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City | HINESVILLE
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State | GA
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Zip | 31313
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Country | US
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Telephone | 912-977-4663
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Fax | 912-369-6530
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Provider Business Mailing Address
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Address Line | 36 COATES RD
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City | HINESVILLE
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State | GA
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Zip | 31313-1013
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Country | US
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Telephone | 912-977-4663
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Fax | 912-369-6530
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Authorized Official
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Title or Position | MEMBER MANAGER
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Name | MR. CHARLES E. TIFT
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Credential | LMSW
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Telephone | 912-977-4663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 012789
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | MSW002656
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License Number State | GA
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