MEDICARE: TIFFANY L CRAIG LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LC1711	MD

General Provider Information

NPI Number	:	1316115827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY L CRAIG LCPC

Provider Business Mailing Address
First Line	:	5305 VILLAGE CENTER DR
Second Line	:	SUITE 215
City	:	COLUMBIA
State	:	MD
Zip	:	21044-2382
Country	:	US
Telephone Number	:	301-814-0171
Fax Number	:

Provider Business Practice Location Address
First Line	:	5305 VILLAGE CENTER DR
Second Line	:	SUITE 215
City	:	COLUMBIA
State	:	MD
Zip	:	21044-2382
Country	:	US
Telephone Number	:	301-814-0171
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2008
Last Update Date	:	05/28/2016

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Directions to “ TIFFANY L CRAIG LCPC” Practice Location

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