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General NPI Number Information
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NPI Number | 1912764424
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Entity Type | Individual
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Provider Name | TIFFANY WILSON LPCC
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Gender | Female
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Dates
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Enumeration Date | 03/01/2024
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Last Update Date | 03/01/2024
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Provider Practice Location Address
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Address Line | 221 AVALON DR
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City | HULL
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State | MA
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Zip | 02045-3415
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Country | US
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Telephone | 617-209-9932
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 156
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City | HINGHAM
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State | MA
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Zip | 02043-0156
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Country | US
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Telephone | 617-209-9932
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 117700
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License Number State | CA
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