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General NPI Number Information
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NPI Number | 1962119024
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Entity Type | Individual
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Provider Name | TIFFANY NICOLE GEORGE
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Gender | Female
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Dates
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Enumeration Date | 10/28/2022
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Last Update Date | 10/28/2022
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Provider Practice Location Address
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Address Line | 4112 INNSLAKE DR
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City | GLEN ALLEN
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State | VA
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Zip | 23060-3344
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Country | US
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Telephone | 804-621-1080
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Fax |
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Provider Business Mailing Address
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Address Line | 230 N 6TH ST UNIT 221
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City | RICHMOND
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State | VA
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Zip | 23219-1876
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Country | US
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Telephone | 757-270-8467
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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 |
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License Number State |
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